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Service Code HCPCS 27784
Hospital Charge Code 5102778401
Hospital Revenue Code 510
Min. Negotiated Rate $331.70
Max. Negotiated Rate $602.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $589.96
Rate for Payer: Aetna of WY Medicare $397.32
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 $349.16
Rate for Payer: HealthUtah PPO $602.00
Rate for Payer: Idaho Integrated Healthcare Commercial $583.94
Rate for Payer: Multiplan Medicare/VA $331.70
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 $349.16
Rate for Payer: United Healthcare Commercial $523.74
Rate for Payer: United Healthcare Medicare $349.16
Rate for Payer: WINHealth Partners Commercial $589.96
Rate for Payer: Wise Provider Network Commercial $571.90
Service Code HCPCS 27792
Hospital Charge Code 5102779201
Hospital Revenue Code 510
Min. Negotiated Rate $381.84
Max. Negotiated Rate $609.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $596.82
Rate for Payer: Altius Auto/Workers Compensation $584.64
Rate for Payer: Altius Commercial $584.64
Rate for Payer: Beech Street Commercial $596.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $499.99
Rate for Payer: Cash Price $426.30
Rate for Payer: ChoiceCare Network Commercial $590.73
Rate for Payer: Cigna of WY Commercial $596.82
Rate for Payer: Entrust Commercial $578.55
Rate for Payer: First Choice Health Commercial $578.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $578.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $401.94
Rate for Payer: HealthUtah PPO $609.00
Rate for Payer: Idaho Integrated Healthcare Commercial $590.73
Rate for Payer: Multiplan Medicare/VA $381.84
Rate for Payer: One Health Plan of WY PPO $596.82
Rate for Payer: PacificSource Commercial $548.10
Rate for Payer: PHCS PPO $596.82
Rate for Payer: Three Rivers PPO $456.75
Rate for Payer: TriWest Veterans Administration $401.94
Rate for Payer: United Healthcare Commercial $529.83
Rate for Payer: United Healthcare Medicare $401.94
Rate for Payer: WINHealth Partners Commercial $578.55
Rate for Payer: Wise Provider Network Commercial $578.55
Service Code HCPCS 27792
Hospital Charge Code 5102779201
Hospital Revenue Code 510
Min. Negotiated Rate $335.56
Max. Negotiated Rate $609.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $596.82
Rate for Payer: Aetna of WY Medicare $401.94
Rate for Payer: Altius Auto/Workers Compensation $584.64
Rate for Payer: Altius Commercial $584.64
Rate for Payer: Beech Street Commercial $596.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $499.99
Rate for Payer: Cash Price $426.30
Rate for Payer: ChoiceCare Network Commercial $590.73
Rate for Payer: Cigna of WY Commercial $596.82
Rate for Payer: Entrust Commercial $578.55
Rate for Payer: First Choice Health Commercial $578.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $578.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $353.22
Rate for Payer: HealthUtah PPO $609.00
Rate for Payer: Idaho Integrated Healthcare Commercial $590.73
Rate for Payer: Multiplan Medicare/VA $335.56
Rate for Payer: One Health Plan of WY PPO $596.82
Rate for Payer: PacificSource Commercial $548.10
Rate for Payer: PHCS PPO $596.82
Rate for Payer: Three Rivers PPO $456.75
Rate for Payer: TriWest Veterans Administration $353.22
Rate for Payer: United Healthcare Commercial $529.83
Rate for Payer: United Healthcare Medicare $353.22
Rate for Payer: WINHealth Partners Commercial $596.82
Rate for Payer: Wise Provider Network Commercial $578.55
Service Code HCPCS 27246
Hospital Charge Code 7612724601
Hospital Revenue Code 761
Min. Negotiated Rate $207.54
Max. Negotiated Rate $331.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $324.38
Rate for Payer: Altius Auto/Workers Compensation $317.76
Rate for Payer: Altius Commercial $317.76
Rate for Payer: Beech Street Commercial $324.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $271.75
Rate for Payer: Cash Price $231.70
Rate for Payer: ChoiceCare Network Commercial $321.07
Rate for Payer: Cigna of WY Commercial $324.38
Rate for Payer: Entrust Commercial $314.45
Rate for Payer: First Choice Health Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $218.46
Rate for Payer: HealthUtah PPO $331.00
Rate for Payer: Idaho Integrated Healthcare Commercial $321.07
Rate for Payer: Multiplan Medicare/VA $207.54
Rate for Payer: One Health Plan of WY PPO $324.38
Rate for Payer: PacificSource Commercial $297.90
Rate for Payer: PHCS PPO $324.38
Rate for Payer: Three Rivers PPO $248.25
Rate for Payer: TriWest Veterans Administration $218.46
Rate for Payer: United Healthcare Commercial $287.97
Rate for Payer: United Healthcare Medicare $218.46
Rate for Payer: WINHealth Partners Commercial $314.45
Rate for Payer: Wise Provider Network Commercial $314.45
Service Code HCPCS 27246
Hospital Charge Code 7612724601
Hospital Revenue Code 761
Min. Negotiated Rate $182.38
Max. Negotiated Rate $331.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $324.38
Rate for Payer: Aetna of WY Medicare $218.46
Rate for Payer: Altius Auto/Workers Compensation $317.76
Rate for Payer: Altius Commercial $317.76
Rate for Payer: Beech Street Commercial $324.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $271.75
Rate for Payer: Cash Price $231.70
Rate for Payer: ChoiceCare Network Commercial $321.07
Rate for Payer: Cigna of WY Commercial $324.38
Rate for Payer: Entrust Commercial $314.45
Rate for Payer: First Choice Health Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $191.98
Rate for Payer: HealthUtah PPO $331.00
Rate for Payer: Idaho Integrated Healthcare Commercial $321.07
Rate for Payer: Multiplan Medicare/VA $182.38
Rate for Payer: One Health Plan of WY PPO $324.38
Rate for Payer: PacificSource Commercial $297.90
Rate for Payer: PHCS PPO $324.38
Rate for Payer: Three Rivers PPO $248.25
Rate for Payer: TriWest Veterans Administration $191.98
Rate for Payer: United Healthcare Commercial $287.97
Rate for Payer: United Healthcare Medicare $191.98
Rate for Payer: WINHealth Partners Commercial $324.38
Rate for Payer: Wise Provider Network Commercial $314.45
Service Code HCPCS 26735
Hospital Charge Code 7612673501
Hospital Revenue Code 761
Min. Negotiated Rate $207.54
Max. Negotiated Rate $331.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $324.38
Rate for Payer: Altius Auto/Workers Compensation $317.76
Rate for Payer: Altius Commercial $317.76
Rate for Payer: Beech Street Commercial $324.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $271.75
Rate for Payer: Cash Price $231.70
Rate for Payer: ChoiceCare Network Commercial $321.07
Rate for Payer: Cigna of WY Commercial $324.38
Rate for Payer: Entrust Commercial $314.45
Rate for Payer: First Choice Health Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $218.46
Rate for Payer: HealthUtah PPO $331.00
Rate for Payer: Idaho Integrated Healthcare Commercial $321.07
Rate for Payer: Multiplan Medicare/VA $207.54
Rate for Payer: One Health Plan of WY PPO $324.38
Rate for Payer: PacificSource Commercial $297.90
Rate for Payer: PHCS PPO $324.38
Rate for Payer: Three Rivers PPO $248.25
Rate for Payer: TriWest Veterans Administration $218.46
Rate for Payer: United Healthcare Commercial $287.97
Rate for Payer: United Healthcare Medicare $218.46
Rate for Payer: WINHealth Partners Commercial $314.45
Rate for Payer: Wise Provider Network Commercial $314.45
Service Code HCPCS 26735
Hospital Charge Code 7612673501
Hospital Revenue Code 761
Min. Negotiated Rate $182.38
Max. Negotiated Rate $331.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $324.38
Rate for Payer: Aetna of WY Medicare $218.46
Rate for Payer: Altius Auto/Workers Compensation $317.76
Rate for Payer: Altius Commercial $317.76
Rate for Payer: Beech Street Commercial $324.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $271.75
Rate for Payer: Cash Price $231.70
Rate for Payer: ChoiceCare Network Commercial $321.07
Rate for Payer: Cigna of WY Commercial $324.38
Rate for Payer: Entrust Commercial $314.45
Rate for Payer: First Choice Health Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $314.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $191.98
Rate for Payer: HealthUtah PPO $331.00
Rate for Payer: Idaho Integrated Healthcare Commercial $321.07
Rate for Payer: Multiplan Medicare/VA $182.38
Rate for Payer: One Health Plan of WY PPO $324.38
Rate for Payer: PacificSource Commercial $297.90
Rate for Payer: PHCS PPO $324.38
Rate for Payer: Three Rivers PPO $248.25
Rate for Payer: TriWest Veterans Administration $191.98
Rate for Payer: United Healthcare Commercial $287.97
Rate for Payer: United Healthcare Medicare $191.98
Rate for Payer: WINHealth Partners Commercial $324.38
Rate for Payer: Wise Provider Network Commercial $314.45
Hospital Charge Code 3600000026
Hospital Revenue Code 360
Min. Negotiated Rate $25.35
Max. Negotiated Rate $46.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $45.08
Rate for Payer: Aetna of WY Medicare $30.36
Rate for Payer: Altius Auto/Workers Compensation $44.16
Rate for Payer: Altius Commercial $44.16
Rate for Payer: Beech Street Commercial $45.08
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $37.77
Rate for Payer: Cash Price $32.20
Rate for Payer: ChoiceCare Network Commercial $44.62
Rate for Payer: Cigna of WY Commercial $45.08
Rate for Payer: Entrust Commercial $43.70
Rate for Payer: First Choice Health Commercial $43.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $43.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $26.68
Rate for Payer: HealthUtah PPO $46.00
Rate for Payer: Idaho Integrated Healthcare Commercial $44.62
Rate for Payer: Multiplan Medicare/VA $25.35
Rate for Payer: One Health Plan of WY PPO $45.08
Rate for Payer: PacificSource Commercial $41.40
Rate for Payer: PHCS PPO $45.08
Rate for Payer: Three Rivers PPO $34.50
Rate for Payer: TriWest Veterans Administration $26.68
Rate for Payer: United Healthcare Commercial $40.02
Rate for Payer: United Healthcare Medicare $26.68
Rate for Payer: WINHealth Partners Commercial $45.08
Rate for Payer: Wise Provider Network Commercial $43.70
Hospital Charge Code 3600000026
Hospital Revenue Code 360
Min. Negotiated Rate $28.84
Max. Negotiated Rate $46.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $45.08
Rate for Payer: Altius Auto/Workers Compensation $44.16
Rate for Payer: Altius Commercial $44.16
Rate for Payer: Beech Street Commercial $45.08
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $37.77
Rate for Payer: Cash Price $32.20
Rate for Payer: ChoiceCare Network Commercial $44.62
Rate for Payer: Cigna of WY Commercial $45.08
Rate for Payer: Entrust Commercial $43.70
Rate for Payer: First Choice Health Commercial $43.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $43.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $30.36
Rate for Payer: HealthUtah PPO $46.00
Rate for Payer: Idaho Integrated Healthcare Commercial $44.62
Rate for Payer: Multiplan Medicare/VA $28.84
Rate for Payer: One Health Plan of WY PPO $45.08
Rate for Payer: PacificSource Commercial $41.40
Rate for Payer: PHCS PPO $45.08
Rate for Payer: Three Rivers PPO $34.50
Rate for Payer: TriWest Veterans Administration $30.36
Rate for Payer: United Healthcare Commercial $40.02
Rate for Payer: United Healthcare Medicare $30.36
Rate for Payer: WINHealth Partners Commercial $43.70
Rate for Payer: Wise Provider Network Commercial $43.70
Hospital Charge Code 3600000023
Hospital Revenue Code 360
Min. Negotiated Rate $33.06
Max. Negotiated Rate $60.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $58.80
Rate for Payer: Aetna of WY Medicare $39.60
Rate for Payer: Altius Auto/Workers Compensation $57.60
Rate for Payer: Altius Commercial $57.60
Rate for Payer: Beech Street Commercial $58.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $49.26
Rate for Payer: Cash Price $42.00
Rate for Payer: ChoiceCare Network Commercial $58.20
Rate for Payer: Cigna of WY Commercial $58.80
Rate for Payer: Entrust Commercial $57.00
Rate for Payer: First Choice Health Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $34.80
Rate for Payer: HealthUtah PPO $60.00
Rate for Payer: Idaho Integrated Healthcare Commercial $58.20
Rate for Payer: Multiplan Medicare/VA $33.06
Rate for Payer: One Health Plan of WY PPO $58.80
Rate for Payer: PacificSource Commercial $54.00
Rate for Payer: PHCS PPO $58.80
Rate for Payer: Three Rivers PPO $45.00
Rate for Payer: TriWest Veterans Administration $34.80
Rate for Payer: United Healthcare Commercial $52.20
Rate for Payer: United Healthcare Medicare $34.80
Rate for Payer: WINHealth Partners Commercial $58.80
Rate for Payer: Wise Provider Network Commercial $57.00
Hospital Charge Code 3600000023
Hospital Revenue Code 360
Min. Negotiated Rate $37.62
Max. Negotiated Rate $60.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $58.80
Rate for Payer: Altius Auto/Workers Compensation $57.60
Rate for Payer: Altius Commercial $57.60
Rate for Payer: Beech Street Commercial $58.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $49.26
Rate for Payer: Cash Price $42.00
Rate for Payer: ChoiceCare Network Commercial $58.20
Rate for Payer: Cigna of WY Commercial $58.80
Rate for Payer: Entrust Commercial $57.00
Rate for Payer: First Choice Health Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $57.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $39.60
Rate for Payer: HealthUtah PPO $60.00
Rate for Payer: Idaho Integrated Healthcare Commercial $58.20
Rate for Payer: Multiplan Medicare/VA $37.62
Rate for Payer: One Health Plan of WY PPO $58.80
Rate for Payer: PacificSource Commercial $54.00
Rate for Payer: PHCS PPO $58.80
Rate for Payer: Three Rivers PPO $45.00
Rate for Payer: TriWest Veterans Administration $39.60
Rate for Payer: United Healthcare Commercial $52.20
Rate for Payer: United Healthcare Medicare $39.60
Rate for Payer: WINHealth Partners Commercial $57.00
Rate for Payer: Wise Provider Network Commercial $57.00
Hospital Charge Code 3600000019
Hospital Revenue Code 360
Min. Negotiated Rate $38.57
Max. Negotiated Rate $70.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $68.60
Rate for Payer: Aetna of WY Medicare $46.20
Rate for Payer: Altius Auto/Workers Compensation $67.20
Rate for Payer: Altius Commercial $67.20
Rate for Payer: Beech Street Commercial $68.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $57.47
Rate for Payer: Cash Price $49.00
Rate for Payer: ChoiceCare Network Commercial $67.90
Rate for Payer: Cigna of WY Commercial $68.60
Rate for Payer: Entrust Commercial $66.50
Rate for Payer: First Choice Health Commercial $66.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $66.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $40.60
Rate for Payer: HealthUtah PPO $70.00
Rate for Payer: Idaho Integrated Healthcare Commercial $67.90
Rate for Payer: Multiplan Medicare/VA $38.57
Rate for Payer: One Health Plan of WY PPO $68.60
Rate for Payer: PacificSource Commercial $63.00
Rate for Payer: PHCS PPO $68.60
Rate for Payer: Three Rivers PPO $52.50
Rate for Payer: TriWest Veterans Administration $40.60
Rate for Payer: United Healthcare Commercial $60.90
Rate for Payer: United Healthcare Medicare $40.60
Rate for Payer: WINHealth Partners Commercial $68.60
Rate for Payer: Wise Provider Network Commercial $66.50
Hospital Charge Code 3600000019
Hospital Revenue Code 360
Min. Negotiated Rate $43.89
Max. Negotiated Rate $70.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $68.60
Rate for Payer: Altius Auto/Workers Compensation $67.20
Rate for Payer: Altius Commercial $67.20
Rate for Payer: Beech Street Commercial $68.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $57.47
Rate for Payer: Cash Price $49.00
Rate for Payer: ChoiceCare Network Commercial $67.90
Rate for Payer: Cigna of WY Commercial $68.60
Rate for Payer: Entrust Commercial $66.50
Rate for Payer: First Choice Health Commercial $66.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $66.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $46.20
Rate for Payer: HealthUtah PPO $70.00
Rate for Payer: Idaho Integrated Healthcare Commercial $67.90
Rate for Payer: Multiplan Medicare/VA $43.89
Rate for Payer: One Health Plan of WY PPO $68.60
Rate for Payer: PacificSource Commercial $63.00
Rate for Payer: PHCS PPO $68.60
Rate for Payer: Three Rivers PPO $52.50
Rate for Payer: TriWest Veterans Administration $46.20
Rate for Payer: United Healthcare Commercial $60.90
Rate for Payer: United Healthcare Medicare $46.20
Rate for Payer: WINHealth Partners Commercial $66.50
Rate for Payer: Wise Provider Network Commercial $66.50
Hospital Charge Code 3600000020
Hospital Revenue Code 360
Min. Negotiated Rate $57.86
Max. Negotiated Rate $105.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $102.90
Rate for Payer: Aetna of WY Medicare $69.30
Rate for Payer: Altius Auto/Workers Compensation $100.80
Rate for Payer: Altius Commercial $100.80
Rate for Payer: Beech Street Commercial $102.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $86.20
Rate for Payer: Cash Price $73.50
Rate for Payer: ChoiceCare Network Commercial $101.85
Rate for Payer: Cigna of WY Commercial $102.90
Rate for Payer: Entrust Commercial $99.75
Rate for Payer: First Choice Health Commercial $99.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $99.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $60.90
Rate for Payer: HealthUtah PPO $105.00
Rate for Payer: Idaho Integrated Healthcare Commercial $101.85
Rate for Payer: Multiplan Medicare/VA $57.86
Rate for Payer: One Health Plan of WY PPO $102.90
Rate for Payer: PacificSource Commercial $94.50
Rate for Payer: PHCS PPO $102.90
Rate for Payer: Three Rivers PPO $78.75
Rate for Payer: TriWest Veterans Administration $60.90
Rate for Payer: United Healthcare Commercial $91.35
Rate for Payer: United Healthcare Medicare $60.90
Rate for Payer: WINHealth Partners Commercial $102.90
Rate for Payer: Wise Provider Network Commercial $99.75
Hospital Charge Code 3600000020
Hospital Revenue Code 360
Min. Negotiated Rate $65.84
Max. Negotiated Rate $105.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $102.90
Rate for Payer: Altius Auto/Workers Compensation $100.80
Rate for Payer: Altius Commercial $100.80
Rate for Payer: Beech Street Commercial $102.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $86.20
Rate for Payer: Cash Price $73.50
Rate for Payer: ChoiceCare Network Commercial $101.85
Rate for Payer: Cigna of WY Commercial $102.90
Rate for Payer: Entrust Commercial $99.75
Rate for Payer: First Choice Health Commercial $99.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $99.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $69.30
Rate for Payer: HealthUtah PPO $105.00
Rate for Payer: Idaho Integrated Healthcare Commercial $101.85
Rate for Payer: Multiplan Medicare/VA $65.84
Rate for Payer: One Health Plan of WY PPO $102.90
Rate for Payer: PacificSource Commercial $94.50
Rate for Payer: PHCS PPO $102.90
Rate for Payer: Three Rivers PPO $78.75
Rate for Payer: TriWest Veterans Administration $69.30
Rate for Payer: United Healthcare Commercial $91.35
Rate for Payer: United Healthcare Medicare $69.30
Rate for Payer: WINHealth Partners Commercial $99.75
Rate for Payer: Wise Provider Network Commercial $99.75
Hospital Charge Code 3600000021
Hospital Revenue Code 360
Min. Negotiated Rate $52.34
Max. Negotiated Rate $95.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $93.10
Rate for Payer: Aetna of WY Medicare $62.70
Rate for Payer: Altius Auto/Workers Compensation $91.20
Rate for Payer: Altius Commercial $91.20
Rate for Payer: Beech Street Commercial $93.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $78.00
Rate for Payer: Cash Price $66.50
Rate for Payer: ChoiceCare Network Commercial $92.15
Rate for Payer: Cigna of WY Commercial $93.10
Rate for Payer: Entrust Commercial $90.25
Rate for Payer: First Choice Health Commercial $90.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $90.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $55.10
Rate for Payer: HealthUtah PPO $95.00
Rate for Payer: Idaho Integrated Healthcare Commercial $92.15
Rate for Payer: Multiplan Medicare/VA $52.34
Rate for Payer: One Health Plan of WY PPO $93.10
Rate for Payer: PacificSource Commercial $85.50
Rate for Payer: PHCS PPO $93.10
Rate for Payer: Three Rivers PPO $71.25
Rate for Payer: TriWest Veterans Administration $55.10
Rate for Payer: United Healthcare Commercial $82.65
Rate for Payer: United Healthcare Medicare $55.10
Rate for Payer: WINHealth Partners Commercial $93.10
Rate for Payer: Wise Provider Network Commercial $90.25
Hospital Charge Code 3600000021
Hospital Revenue Code 360
Min. Negotiated Rate $59.56
Max. Negotiated Rate $95.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $93.10
Rate for Payer: Altius Auto/Workers Compensation $91.20
Rate for Payer: Altius Commercial $91.20
Rate for Payer: Beech Street Commercial $93.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $78.00
Rate for Payer: Cash Price $66.50
Rate for Payer: ChoiceCare Network Commercial $92.15
Rate for Payer: Cigna of WY Commercial $93.10
Rate for Payer: Entrust Commercial $90.25
Rate for Payer: First Choice Health Commercial $90.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $90.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $62.70
Rate for Payer: HealthUtah PPO $95.00
Rate for Payer: Idaho Integrated Healthcare Commercial $92.15
Rate for Payer: Multiplan Medicare/VA $59.56
Rate for Payer: One Health Plan of WY PPO $93.10
Rate for Payer: PacificSource Commercial $85.50
Rate for Payer: PHCS PPO $93.10
Rate for Payer: Three Rivers PPO $71.25
Rate for Payer: TriWest Veterans Administration $62.70
Rate for Payer: United Healthcare Commercial $82.65
Rate for Payer: United Healthcare Medicare $62.70
Rate for Payer: WINHealth Partners Commercial $90.25
Rate for Payer: Wise Provider Network Commercial $90.25
Hospital Charge Code 3600000022
Hospital Revenue Code 360
Min. Negotiated Rate $44.08
Max. Negotiated Rate $80.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $78.40
Rate for Payer: Aetna of WY Medicare $52.80
Rate for Payer: Altius Auto/Workers Compensation $76.80
Rate for Payer: Altius Commercial $76.80
Rate for Payer: Beech Street Commercial $78.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $65.68
Rate for Payer: Cash Price $56.00
Rate for Payer: ChoiceCare Network Commercial $77.60
Rate for Payer: Cigna of WY Commercial $78.40
Rate for Payer: Entrust Commercial $76.00
Rate for Payer: First Choice Health Commercial $76.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $76.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $46.40
Rate for Payer: HealthUtah PPO $80.00
Rate for Payer: Idaho Integrated Healthcare Commercial $77.60
Rate for Payer: Multiplan Medicare/VA $44.08
Rate for Payer: One Health Plan of WY PPO $78.40
Rate for Payer: PacificSource Commercial $72.00
Rate for Payer: PHCS PPO $78.40
Rate for Payer: Three Rivers PPO $60.00
Rate for Payer: TriWest Veterans Administration $46.40
Rate for Payer: United Healthcare Commercial $69.60
Rate for Payer: United Healthcare Medicare $46.40
Rate for Payer: WINHealth Partners Commercial $78.40
Rate for Payer: Wise Provider Network Commercial $76.00
Hospital Charge Code 3600000022
Hospital Revenue Code 360
Min. Negotiated Rate $50.16
Max. Negotiated Rate $80.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $78.40
Rate for Payer: Altius Auto/Workers Compensation $76.80
Rate for Payer: Altius Commercial $76.80
Rate for Payer: Beech Street Commercial $78.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $65.68
Rate for Payer: Cash Price $56.00
Rate for Payer: ChoiceCare Network Commercial $77.60
Rate for Payer: Cigna of WY Commercial $78.40
Rate for Payer: Entrust Commercial $76.00
Rate for Payer: First Choice Health Commercial $76.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $76.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $52.80
Rate for Payer: HealthUtah PPO $80.00
Rate for Payer: Idaho Integrated Healthcare Commercial $77.60
Rate for Payer: Multiplan Medicare/VA $50.16
Rate for Payer: One Health Plan of WY PPO $78.40
Rate for Payer: PacificSource Commercial $72.00
Rate for Payer: PHCS PPO $78.40
Rate for Payer: Three Rivers PPO $60.00
Rate for Payer: TriWest Veterans Administration $52.80
Rate for Payer: United Healthcare Commercial $69.60
Rate for Payer: United Healthcare Medicare $52.80
Rate for Payer: WINHealth Partners Commercial $76.00
Rate for Payer: Wise Provider Network Commercial $76.00
Hospital Charge Code 3600000010
Hospital Revenue Code 360
Min. Negotiated Rate $245.20
Max. Negotiated Rate $445.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $436.10
Rate for Payer: Aetna of WY Medicare $293.70
Rate for Payer: Altius Auto/Workers Compensation $427.20
Rate for Payer: Altius Commercial $427.20
Rate for Payer: Beech Street Commercial $436.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $365.34
Rate for Payer: Cash Price $311.50
Rate for Payer: ChoiceCare Network Commercial $431.65
Rate for Payer: Cigna of WY Commercial $436.10
Rate for Payer: Entrust Commercial $422.75
Rate for Payer: First Choice Health Commercial $422.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $422.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $258.10
Rate for Payer: HealthUtah PPO $445.00
Rate for Payer: Idaho Integrated Healthcare Commercial $431.65
Rate for Payer: Multiplan Medicare/VA $245.20
Rate for Payer: One Health Plan of WY PPO $436.10
Rate for Payer: PacificSource Commercial $400.50
Rate for Payer: PHCS PPO $436.10
Rate for Payer: Three Rivers PPO $333.75
Rate for Payer: TriWest Veterans Administration $258.10
Rate for Payer: United Healthcare Commercial $387.15
Rate for Payer: United Healthcare Medicare $258.10
Rate for Payer: WINHealth Partners Commercial $436.10
Rate for Payer: Wise Provider Network Commercial $422.75
Hospital Charge Code 3600000010
Hospital Revenue Code 360
Min. Negotiated Rate $279.02
Max. Negotiated Rate $445.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $436.10
Rate for Payer: Altius Auto/Workers Compensation $427.20
Rate for Payer: Altius Commercial $427.20
Rate for Payer: Beech Street Commercial $436.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $365.34
Rate for Payer: Cash Price $311.50
Rate for Payer: ChoiceCare Network Commercial $431.65
Rate for Payer: Cigna of WY Commercial $436.10
Rate for Payer: Entrust Commercial $422.75
Rate for Payer: First Choice Health Commercial $422.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $422.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $293.70
Rate for Payer: HealthUtah PPO $445.00
Rate for Payer: Idaho Integrated Healthcare Commercial $431.65
Rate for Payer: Multiplan Medicare/VA $279.02
Rate for Payer: One Health Plan of WY PPO $436.10
Rate for Payer: PacificSource Commercial $400.50
Rate for Payer: PHCS PPO $436.10
Rate for Payer: Three Rivers PPO $333.75
Rate for Payer: TriWest Veterans Administration $293.70
Rate for Payer: United Healthcare Commercial $387.15
Rate for Payer: United Healthcare Medicare $293.70
Rate for Payer: WINHealth Partners Commercial $422.75
Rate for Payer: Wise Provider Network Commercial $422.75
Hospital Charge Code 3600000016
Hospital Revenue Code 360
Min. Negotiated Rate $1,567.60
Max. Negotiated Rate $2,845.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,788.10
Rate for Payer: Aetna of WY Medicare $1,877.70
Rate for Payer: Altius Auto/Workers Compensation $2,731.20
Rate for Payer: Altius Commercial $2,731.20
Rate for Payer: Beech Street Commercial $2,788.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,335.74
Rate for Payer: Cash Price $1,991.50
Rate for Payer: ChoiceCare Network Commercial $2,759.65
Rate for Payer: Cigna of WY Commercial $2,788.10
Rate for Payer: Entrust Commercial $2,702.75
Rate for Payer: First Choice Health Commercial $2,702.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,702.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,650.10
Rate for Payer: HealthUtah PPO $2,845.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,759.65
Rate for Payer: Multiplan Medicare/VA $1,567.60
Rate for Payer: One Health Plan of WY PPO $2,788.10
Rate for Payer: PacificSource Commercial $2,560.50
Rate for Payer: PHCS PPO $2,788.10
Rate for Payer: Three Rivers PPO $2,133.75
Rate for Payer: TriWest Veterans Administration $1,650.10
Rate for Payer: United Healthcare Commercial $2,475.15
Rate for Payer: United Healthcare Medicare $1,650.10
Rate for Payer: WINHealth Partners Commercial $2,788.10
Rate for Payer: Wise Provider Network Commercial $2,702.75
Hospital Charge Code 3600000016
Hospital Revenue Code 360
Min. Negotiated Rate $1,783.82
Max. Negotiated Rate $2,845.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,788.10
Rate for Payer: Altius Auto/Workers Compensation $2,731.20
Rate for Payer: Altius Commercial $2,731.20
Rate for Payer: Beech Street Commercial $2,788.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,335.74
Rate for Payer: Cash Price $1,991.50
Rate for Payer: ChoiceCare Network Commercial $2,759.65
Rate for Payer: Cigna of WY Commercial $2,788.10
Rate for Payer: Entrust Commercial $2,702.75
Rate for Payer: First Choice Health Commercial $2,702.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,702.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,877.70
Rate for Payer: HealthUtah PPO $2,845.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,759.65
Rate for Payer: Multiplan Medicare/VA $1,783.82
Rate for Payer: One Health Plan of WY PPO $2,788.10
Rate for Payer: PacificSource Commercial $2,560.50
Rate for Payer: PHCS PPO $2,788.10
Rate for Payer: Three Rivers PPO $2,133.75
Rate for Payer: TriWest Veterans Administration $1,877.70
Rate for Payer: United Healthcare Commercial $2,475.15
Rate for Payer: United Healthcare Medicare $1,877.70
Rate for Payer: WINHealth Partners Commercial $2,702.75
Rate for Payer: Wise Provider Network Commercial $2,702.75
Service Code HCPCS 97760
Hospital Charge Code 5109776001
Hospital Revenue Code 510
Min. Negotiated Rate $19.28
Max. Negotiated Rate $35.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $34.30
Rate for Payer: Aetna of WY Medicare $23.10
Rate for Payer: Altius Auto/Workers Compensation $33.60
Rate for Payer: Altius Commercial $33.60
Rate for Payer: Beech Street Commercial $34.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $28.74
Rate for Payer: Cash Price $24.50
Rate for Payer: ChoiceCare Network Commercial $33.95
Rate for Payer: Cigna of WY Commercial $34.30
Rate for Payer: Entrust Commercial $33.25
Rate for Payer: First Choice Health Commercial $33.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $33.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $20.30
Rate for Payer: HealthUtah PPO $35.00
Rate for Payer: Idaho Integrated Healthcare Commercial $33.95
Rate for Payer: Multiplan Medicare/VA $19.28
Rate for Payer: One Health Plan of WY PPO $34.30
Rate for Payer: PacificSource Commercial $31.50
Rate for Payer: PHCS PPO $34.30
Rate for Payer: Three Rivers PPO $26.25
Rate for Payer: TriWest Veterans Administration $20.30
Rate for Payer: United Healthcare Commercial $30.45
Rate for Payer: United Healthcare Medicare $20.30
Rate for Payer: WINHealth Partners Commercial $34.30
Rate for Payer: Wise Provider Network Commercial $33.25
Service Code HCPCS 97760
Hospital Charge Code 5109776001
Hospital Revenue Code 510
Min. Negotiated Rate $21.94
Max. Negotiated Rate $35.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $34.30
Rate for Payer: Altius Auto/Workers Compensation $33.60
Rate for Payer: Altius Commercial $33.60
Rate for Payer: Beech Street Commercial $34.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $28.74
Rate for Payer: Cash Price $24.50
Rate for Payer: ChoiceCare Network Commercial $33.95
Rate for Payer: Cigna of WY Commercial $34.30
Rate for Payer: Entrust Commercial $33.25
Rate for Payer: First Choice Health Commercial $33.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $33.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $23.10
Rate for Payer: HealthUtah PPO $35.00
Rate for Payer: Idaho Integrated Healthcare Commercial $33.95
Rate for Payer: Multiplan Medicare/VA $21.94
Rate for Payer: One Health Plan of WY PPO $34.30
Rate for Payer: PacificSource Commercial $31.50
Rate for Payer: PHCS PPO $34.30
Rate for Payer: Three Rivers PPO $26.25
Rate for Payer: TriWest Veterans Administration $23.10
Rate for Payer: United Healthcare Commercial $30.45
Rate for Payer: United Healthcare Medicare $23.10
Rate for Payer: WINHealth Partners Commercial $33.25
Rate for Payer: Wise Provider Network Commercial $33.25