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Hospital Charge Code 3600000009
Hospital Revenue Code 360
Min. Negotiated Rate $275.50
Max. Negotiated Rate $500.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $490.00
Rate for Payer: Aetna of WY Medicare $330.00
Rate for Payer: Altius Auto/Workers Compensation $480.00
Rate for Payer: Altius Commercial $480.00
Rate for Payer: Beech Street Commercial $490.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $410.50
Rate for Payer: Cash Price $350.00
Rate for Payer: ChoiceCare Network Commercial $485.00
Rate for Payer: Cigna of WY Commercial $490.00
Rate for Payer: Entrust Commercial $475.00
Rate for Payer: First Choice Health Commercial $475.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $475.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $290.00
Rate for Payer: HealthUtah PPO $500.00
Rate for Payer: Idaho Integrated Healthcare Commercial $485.00
Rate for Payer: Multiplan Medicare/VA $275.50
Rate for Payer: One Health Plan of WY PPO $490.00
Rate for Payer: PacificSource Commercial $450.00
Rate for Payer: PHCS PPO $490.00
Rate for Payer: Three Rivers PPO $375.00
Rate for Payer: TriWest Veterans Administration $290.00
Rate for Payer: United Healthcare Commercial $435.00
Rate for Payer: United Healthcare Medicare $290.00
Rate for Payer: WINHealth Partners Commercial $490.00
Rate for Payer: Wise Provider Network Commercial $475.00
Hospital Charge Code 3600000009
Hospital Revenue Code 360
Min. Negotiated Rate $313.50
Max. Negotiated Rate $500.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $490.00
Rate for Payer: Altius Auto/Workers Compensation $480.00
Rate for Payer: Altius Commercial $480.00
Rate for Payer: Beech Street Commercial $490.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $410.50
Rate for Payer: Cash Price $350.00
Rate for Payer: ChoiceCare Network Commercial $485.00
Rate for Payer: Cigna of WY Commercial $490.00
Rate for Payer: Entrust Commercial $475.00
Rate for Payer: First Choice Health Commercial $475.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $475.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $330.00
Rate for Payer: HealthUtah PPO $500.00
Rate for Payer: Idaho Integrated Healthcare Commercial $485.00
Rate for Payer: Multiplan Medicare/VA $313.50
Rate for Payer: One Health Plan of WY PPO $490.00
Rate for Payer: PacificSource Commercial $450.00
Rate for Payer: PHCS PPO $490.00
Rate for Payer: Three Rivers PPO $375.00
Rate for Payer: TriWest Veterans Administration $330.00
Rate for Payer: United Healthcare Commercial $435.00
Rate for Payer: United Healthcare Medicare $330.00
Rate for Payer: WINHealth Partners Commercial $475.00
Rate for Payer: Wise Provider Network Commercial $475.00
Hospital Charge Code 3600000024
Hospital Revenue Code 360
Min. Negotiated Rate $1,024.86
Max. Negotiated Rate $1,860.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,822.80
Rate for Payer: Aetna of WY Medicare $1,227.60
Rate for Payer: Altius Auto/Workers Compensation $1,785.60
Rate for Payer: Altius Commercial $1,785.60
Rate for Payer: Beech Street Commercial $1,822.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,527.06
Rate for Payer: Cash Price $1,302.00
Rate for Payer: ChoiceCare Network Commercial $1,804.20
Rate for Payer: Cigna of WY Commercial $1,822.80
Rate for Payer: Entrust Commercial $1,767.00
Rate for Payer: First Choice Health Commercial $1,767.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,767.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,078.80
Rate for Payer: HealthUtah PPO $1,860.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,804.20
Rate for Payer: Multiplan Medicare/VA $1,024.86
Rate for Payer: One Health Plan of WY PPO $1,822.80
Rate for Payer: PacificSource Commercial $1,674.00
Rate for Payer: PHCS PPO $1,822.80
Rate for Payer: Three Rivers PPO $1,395.00
Rate for Payer: TriWest Veterans Administration $1,078.80
Rate for Payer: United Healthcare Commercial $1,618.20
Rate for Payer: United Healthcare Medicare $1,078.80
Rate for Payer: WINHealth Partners Commercial $1,822.80
Rate for Payer: Wise Provider Network Commercial $1,767.00
Hospital Charge Code 3600000024
Hospital Revenue Code 360
Min. Negotiated Rate $1,166.22
Max. Negotiated Rate $1,860.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,822.80
Rate for Payer: Altius Auto/Workers Compensation $1,785.60
Rate for Payer: Altius Commercial $1,785.60
Rate for Payer: Beech Street Commercial $1,822.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,527.06
Rate for Payer: Cash Price $1,302.00
Rate for Payer: ChoiceCare Network Commercial $1,804.20
Rate for Payer: Cigna of WY Commercial $1,822.80
Rate for Payer: Entrust Commercial $1,767.00
Rate for Payer: First Choice Health Commercial $1,767.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,767.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,227.60
Rate for Payer: HealthUtah PPO $1,860.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,804.20
Rate for Payer: Multiplan Medicare/VA $1,166.22
Rate for Payer: One Health Plan of WY PPO $1,822.80
Rate for Payer: PacificSource Commercial $1,674.00
Rate for Payer: PHCS PPO $1,822.80
Rate for Payer: Three Rivers PPO $1,395.00
Rate for Payer: TriWest Veterans Administration $1,227.60
Rate for Payer: United Healthcare Commercial $1,618.20
Rate for Payer: United Healthcare Medicare $1,227.60
Rate for Payer: WINHealth Partners Commercial $1,767.00
Rate for Payer: Wise Provider Network Commercial $1,767.00
Hospital Charge Code 3600000028
Hospital Revenue Code 360
Min. Negotiated Rate $702.52
Max. Negotiated Rate $1,275.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,249.50
Rate for Payer: Aetna of WY Medicare $841.50
Rate for Payer: Altius Auto/Workers Compensation $1,224.00
Rate for Payer: Altius Commercial $1,224.00
Rate for Payer: Beech Street Commercial $1,249.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,046.78
Rate for Payer: Cash Price $892.50
Rate for Payer: ChoiceCare Network Commercial $1,236.75
Rate for Payer: Cigna of WY Commercial $1,249.50
Rate for Payer: Entrust Commercial $1,211.25
Rate for Payer: First Choice Health Commercial $1,211.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,211.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $739.50
Rate for Payer: HealthUtah PPO $1,275.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,236.75
Rate for Payer: Multiplan Medicare/VA $702.52
Rate for Payer: One Health Plan of WY PPO $1,249.50
Rate for Payer: PacificSource Commercial $1,147.50
Rate for Payer: PHCS PPO $1,249.50
Rate for Payer: Three Rivers PPO $956.25
Rate for Payer: TriWest Veterans Administration $739.50
Rate for Payer: United Healthcare Commercial $1,109.25
Rate for Payer: United Healthcare Medicare $739.50
Rate for Payer: WINHealth Partners Commercial $1,249.50
Rate for Payer: Wise Provider Network Commercial $1,211.25
Hospital Charge Code 3600000028
Hospital Revenue Code 360
Min. Negotiated Rate $799.42
Max. Negotiated Rate $1,275.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,249.50
Rate for Payer: Altius Auto/Workers Compensation $1,224.00
Rate for Payer: Altius Commercial $1,224.00
Rate for Payer: Beech Street Commercial $1,249.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,046.78
Rate for Payer: Cash Price $892.50
Rate for Payer: ChoiceCare Network Commercial $1,236.75
Rate for Payer: Cigna of WY Commercial $1,249.50
Rate for Payer: Entrust Commercial $1,211.25
Rate for Payer: First Choice Health Commercial $1,211.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,211.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $841.50
Rate for Payer: HealthUtah PPO $1,275.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,236.75
Rate for Payer: Multiplan Medicare/VA $799.42
Rate for Payer: One Health Plan of WY PPO $1,249.50
Rate for Payer: PacificSource Commercial $1,147.50
Rate for Payer: PHCS PPO $1,249.50
Rate for Payer: Three Rivers PPO $956.25
Rate for Payer: TriWest Veterans Administration $841.50
Rate for Payer: United Healthcare Commercial $1,109.25
Rate for Payer: United Healthcare Medicare $841.50
Rate for Payer: WINHealth Partners Commercial $1,211.25
Rate for Payer: Wise Provider Network Commercial $1,211.25
Service Code HCPCS 98925
Hospital Charge Code 5109892501
Hospital Revenue Code 510
Min. Negotiated Rate $15.68
Max. Negotiated Rate $25.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.50
Rate for Payer: Altius Auto/Workers Compensation $24.00
Rate for Payer: Altius Commercial $24.00
Rate for Payer: Beech Street Commercial $24.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.52
Rate for Payer: Cash Price $17.50
Rate for Payer: ChoiceCare Network Commercial $24.25
Rate for Payer: Cigna of WY Commercial $24.50
Rate for Payer: Entrust Commercial $23.75
Rate for Payer: First Choice Health Commercial $23.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.50
Rate for Payer: HealthUtah PPO $25.00
Rate for Payer: Idaho Integrated Healthcare Commercial $24.25
Rate for Payer: Multiplan Medicare/VA $15.68
Rate for Payer: One Health Plan of WY PPO $24.50
Rate for Payer: PacificSource Commercial $22.50
Rate for Payer: PHCS PPO $24.50
Rate for Payer: Three Rivers PPO $18.75
Rate for Payer: TriWest Veterans Administration $16.50
Rate for Payer: United Healthcare Commercial $21.75
Rate for Payer: United Healthcare Medicare $16.50
Rate for Payer: WINHealth Partners Commercial $23.75
Rate for Payer: Wise Provider Network Commercial $23.75
Service Code HCPCS 98925
Hospital Charge Code 5109892501
Hospital Revenue Code 510
Min. Negotiated Rate $13.78
Max. Negotiated Rate $25.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.50
Rate for Payer: Aetna of WY Medicare $16.50
Rate for Payer: Altius Auto/Workers Compensation $24.00
Rate for Payer: Altius Commercial $24.00
Rate for Payer: Beech Street Commercial $24.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.52
Rate for Payer: Cash Price $17.50
Rate for Payer: ChoiceCare Network Commercial $24.25
Rate for Payer: Cigna of WY Commercial $24.50
Rate for Payer: Entrust Commercial $23.75
Rate for Payer: First Choice Health Commercial $23.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $14.50
Rate for Payer: HealthUtah PPO $25.00
Rate for Payer: Idaho Integrated Healthcare Commercial $24.25
Rate for Payer: Multiplan Medicare/VA $13.78
Rate for Payer: One Health Plan of WY PPO $24.50
Rate for Payer: PacificSource Commercial $22.50
Rate for Payer: PHCS PPO $24.50
Rate for Payer: Three Rivers PPO $18.75
Rate for Payer: TriWest Veterans Administration $14.50
Rate for Payer: United Healthcare Commercial $21.75
Rate for Payer: United Healthcare Medicare $14.50
Rate for Payer: WINHealth Partners Commercial $24.50
Rate for Payer: Wise Provider Network Commercial $23.75
Service Code HCPCS 98925
Hospital Charge Code 7619892501
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 98925
Hospital Charge Code 7619892501
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 98926
Hospital Charge Code 5109892601
Hospital Revenue Code 510
Min. Negotiated Rate $16.93
Max. Negotiated Rate $27.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $26.46
Rate for Payer: Altius Auto/Workers Compensation $25.92
Rate for Payer: Altius Commercial $25.92
Rate for Payer: Beech Street Commercial $26.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $22.17
Rate for Payer: Cash Price $18.90
Rate for Payer: ChoiceCare Network Commercial $26.19
Rate for Payer: Cigna of WY Commercial $26.46
Rate for Payer: Entrust Commercial $25.65
Rate for Payer: First Choice Health Commercial $25.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $25.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.82
Rate for Payer: HealthUtah PPO $27.00
Rate for Payer: Idaho Integrated Healthcare Commercial $26.19
Rate for Payer: Multiplan Medicare/VA $16.93
Rate for Payer: One Health Plan of WY PPO $26.46
Rate for Payer: PacificSource Commercial $24.30
Rate for Payer: PHCS PPO $26.46
Rate for Payer: Three Rivers PPO $20.25
Rate for Payer: TriWest Veterans Administration $17.82
Rate for Payer: United Healthcare Commercial $23.49
Rate for Payer: United Healthcare Medicare $17.82
Rate for Payer: WINHealth Partners Commercial $25.65
Rate for Payer: Wise Provider Network Commercial $25.65
Service Code HCPCS 98926
Hospital Charge Code 5109892601
Hospital Revenue Code 510
Min. Negotiated Rate $14.88
Max. Negotiated Rate $27.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $26.46
Rate for Payer: Aetna of WY Medicare $17.82
Rate for Payer: Altius Auto/Workers Compensation $25.92
Rate for Payer: Altius Commercial $25.92
Rate for Payer: Beech Street Commercial $26.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $22.17
Rate for Payer: Cash Price $18.90
Rate for Payer: ChoiceCare Network Commercial $26.19
Rate for Payer: Cigna of WY Commercial $26.46
Rate for Payer: Entrust Commercial $25.65
Rate for Payer: First Choice Health Commercial $25.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $25.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $15.66
Rate for Payer: HealthUtah PPO $27.00
Rate for Payer: Idaho Integrated Healthcare Commercial $26.19
Rate for Payer: Multiplan Medicare/VA $14.88
Rate for Payer: One Health Plan of WY PPO $26.46
Rate for Payer: PacificSource Commercial $24.30
Rate for Payer: PHCS PPO $26.46
Rate for Payer: Three Rivers PPO $20.25
Rate for Payer: TriWest Veterans Administration $15.66
Rate for Payer: United Healthcare Commercial $23.49
Rate for Payer: United Healthcare Medicare $15.66
Rate for Payer: WINHealth Partners Commercial $26.46
Rate for Payer: Wise Provider Network Commercial $25.65
Service Code HCPCS 98926
Hospital Charge Code 7619892601
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 98926
Hospital Charge Code 7619892601
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 98927
Hospital Charge Code 7619892701
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 98927
Hospital Charge Code 7619892701
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 98927
Hospital Charge Code 5109892701
Hospital Revenue Code 510
Min. Negotiated Rate $21.49
Max. Negotiated Rate $39.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $38.22
Rate for Payer: Aetna of WY Medicare $25.74
Rate for Payer: Altius Auto/Workers Compensation $37.44
Rate for Payer: Altius Commercial $37.44
Rate for Payer: Beech Street Commercial $38.22
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $32.02
Rate for Payer: Cash Price $27.30
Rate for Payer: ChoiceCare Network Commercial $37.83
Rate for Payer: Cigna of WY Commercial $38.22
Rate for Payer: Entrust Commercial $37.05
Rate for Payer: First Choice Health Commercial $37.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $37.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $22.62
Rate for Payer: HealthUtah PPO $39.00
Rate for Payer: Idaho Integrated Healthcare Commercial $37.83
Rate for Payer: Multiplan Medicare/VA $21.49
Rate for Payer: One Health Plan of WY PPO $38.22
Rate for Payer: PacificSource Commercial $35.10
Rate for Payer: PHCS PPO $38.22
Rate for Payer: Three Rivers PPO $29.25
Rate for Payer: TriWest Veterans Administration $22.62
Rate for Payer: United Healthcare Commercial $33.93
Rate for Payer: United Healthcare Medicare $22.62
Rate for Payer: WINHealth Partners Commercial $38.22
Rate for Payer: Wise Provider Network Commercial $37.05
Service Code HCPCS 98927
Hospital Charge Code 5109892701
Hospital Revenue Code 510
Min. Negotiated Rate $24.45
Max. Negotiated Rate $39.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $38.22
Rate for Payer: Altius Auto/Workers Compensation $37.44
Rate for Payer: Altius Commercial $37.44
Rate for Payer: Beech Street Commercial $38.22
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $32.02
Rate for Payer: Cash Price $27.30
Rate for Payer: ChoiceCare Network Commercial $37.83
Rate for Payer: Cigna of WY Commercial $38.22
Rate for Payer: Entrust Commercial $37.05
Rate for Payer: First Choice Health Commercial $37.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $37.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $25.74
Rate for Payer: HealthUtah PPO $39.00
Rate for Payer: Idaho Integrated Healthcare Commercial $37.83
Rate for Payer: Multiplan Medicare/VA $24.45
Rate for Payer: One Health Plan of WY PPO $38.22
Rate for Payer: PacificSource Commercial $35.10
Rate for Payer: PHCS PPO $38.22
Rate for Payer: Three Rivers PPO $29.25
Rate for Payer: TriWest Veterans Administration $25.74
Rate for Payer: United Healthcare Commercial $33.93
Rate for Payer: United Healthcare Medicare $25.74
Rate for Payer: WINHealth Partners Commercial $37.05
Rate for Payer: Wise Provider Network Commercial $37.05
Service Code HCPCS 98928
Hospital Charge Code 5109892801
Hospital Revenue Code 510
Min. Negotiated Rate $27.59
Max. Negotiated Rate $44.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $43.12
Rate for Payer: Altius Auto/Workers Compensation $42.24
Rate for Payer: Altius Commercial $42.24
Rate for Payer: Beech Street Commercial $43.12
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $36.12
Rate for Payer: Cash Price $30.80
Rate for Payer: ChoiceCare Network Commercial $42.68
Rate for Payer: Cigna of WY Commercial $43.12
Rate for Payer: Entrust Commercial $41.80
Rate for Payer: First Choice Health Commercial $41.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $41.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $29.04
Rate for Payer: HealthUtah PPO $44.00
Rate for Payer: Idaho Integrated Healthcare Commercial $42.68
Rate for Payer: Multiplan Medicare/VA $27.59
Rate for Payer: One Health Plan of WY PPO $43.12
Rate for Payer: PacificSource Commercial $39.60
Rate for Payer: PHCS PPO $43.12
Rate for Payer: Three Rivers PPO $33.00
Rate for Payer: TriWest Veterans Administration $29.04
Rate for Payer: United Healthcare Commercial $38.28
Rate for Payer: United Healthcare Medicare $29.04
Rate for Payer: WINHealth Partners Commercial $41.80
Rate for Payer: Wise Provider Network Commercial $41.80
Service Code HCPCS 98928
Hospital Charge Code 5109892801
Hospital Revenue Code 510
Min. Negotiated Rate $24.24
Max. Negotiated Rate $44.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $43.12
Rate for Payer: Aetna of WY Medicare $29.04
Rate for Payer: Altius Auto/Workers Compensation $42.24
Rate for Payer: Altius Commercial $42.24
Rate for Payer: Beech Street Commercial $43.12
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $36.12
Rate for Payer: Cash Price $30.80
Rate for Payer: ChoiceCare Network Commercial $42.68
Rate for Payer: Cigna of WY Commercial $43.12
Rate for Payer: Entrust Commercial $41.80
Rate for Payer: First Choice Health Commercial $41.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $41.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $25.52
Rate for Payer: HealthUtah PPO $44.00
Rate for Payer: Idaho Integrated Healthcare Commercial $42.68
Rate for Payer: Multiplan Medicare/VA $24.24
Rate for Payer: One Health Plan of WY PPO $43.12
Rate for Payer: PacificSource Commercial $39.60
Rate for Payer: PHCS PPO $43.12
Rate for Payer: Three Rivers PPO $33.00
Rate for Payer: TriWest Veterans Administration $25.52
Rate for Payer: United Healthcare Commercial $38.28
Rate for Payer: United Healthcare Medicare $25.52
Rate for Payer: WINHealth Partners Commercial $43.12
Rate for Payer: Wise Provider Network Commercial $41.80
Service Code HCPCS 98929
Hospital Charge Code 5109892901
Hospital Revenue Code 510
Min. Negotiated Rate $29.47
Max. Negotiated Rate $47.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $46.06
Rate for Payer: Altius Auto/Workers Compensation $45.12
Rate for Payer: Altius Commercial $45.12
Rate for Payer: Beech Street Commercial $46.06
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $38.59
Rate for Payer: Cash Price $32.90
Rate for Payer: ChoiceCare Network Commercial $45.59
Rate for Payer: Cigna of WY Commercial $46.06
Rate for Payer: Entrust Commercial $44.65
Rate for Payer: First Choice Health Commercial $44.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $44.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $31.02
Rate for Payer: HealthUtah PPO $47.00
Rate for Payer: Idaho Integrated Healthcare Commercial $45.59
Rate for Payer: Multiplan Medicare/VA $29.47
Rate for Payer: One Health Plan of WY PPO $46.06
Rate for Payer: PacificSource Commercial $42.30
Rate for Payer: PHCS PPO $46.06
Rate for Payer: Three Rivers PPO $35.25
Rate for Payer: TriWest Veterans Administration $31.02
Rate for Payer: United Healthcare Commercial $40.89
Rate for Payer: United Healthcare Medicare $31.02
Rate for Payer: WINHealth Partners Commercial $44.65
Rate for Payer: Wise Provider Network Commercial $44.65
Service Code HCPCS 98929
Hospital Charge Code 5109892901
Hospital Revenue Code 510
Min. Negotiated Rate $25.90
Max. Negotiated Rate $47.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $46.06
Rate for Payer: Aetna of WY Medicare $31.02
Rate for Payer: Altius Auto/Workers Compensation $45.12
Rate for Payer: Altius Commercial $45.12
Rate for Payer: Beech Street Commercial $46.06
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $38.59
Rate for Payer: Cash Price $32.90
Rate for Payer: ChoiceCare Network Commercial $45.59
Rate for Payer: Cigna of WY Commercial $46.06
Rate for Payer: Entrust Commercial $44.65
Rate for Payer: First Choice Health Commercial $44.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $44.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $27.26
Rate for Payer: HealthUtah PPO $47.00
Rate for Payer: Idaho Integrated Healthcare Commercial $45.59
Rate for Payer: Multiplan Medicare/VA $25.90
Rate for Payer: One Health Plan of WY PPO $46.06
Rate for Payer: PacificSource Commercial $42.30
Rate for Payer: PHCS PPO $46.06
Rate for Payer: Three Rivers PPO $35.25
Rate for Payer: TriWest Veterans Administration $27.26
Rate for Payer: United Healthcare Commercial $40.89
Rate for Payer: United Healthcare Medicare $27.26
Rate for Payer: WINHealth Partners Commercial $46.06
Rate for Payer: Wise Provider Network Commercial $44.65
Hospital Charge Code 4200000004
Hospital Revenue Code 420
Min. Negotiated Rate $60.61
Max. Negotiated Rate $110.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $107.80
Rate for Payer: Aetna of WY Medicare $72.60
Rate for Payer: Altius Auto/Workers Compensation $105.60
Rate for Payer: Altius Commercial $105.60
Rate for Payer: Beech Street Commercial $107.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $90.31
Rate for Payer: Cash Price $77.00
Rate for Payer: ChoiceCare Network Commercial $106.70
Rate for Payer: Cigna of WY Commercial $107.80
Rate for Payer: Entrust Commercial $104.50
Rate for Payer: First Choice Health Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $63.80
Rate for Payer: HealthUtah PPO $110.00
Rate for Payer: Idaho Integrated Healthcare Commercial $106.70
Rate for Payer: Multiplan Medicare/VA $60.61
Rate for Payer: One Health Plan of WY PPO $107.80
Rate for Payer: PacificSource Commercial $99.00
Rate for Payer: PHCS PPO $107.80
Rate for Payer: Three Rivers PPO $82.50
Rate for Payer: TriWest Veterans Administration $63.80
Rate for Payer: United Healthcare Commercial $95.70
Rate for Payer: United Healthcare Medicare $63.80
Rate for Payer: WINHealth Partners Commercial $107.80
Rate for Payer: Wise Provider Network Commercial $104.50
Hospital Charge Code 4200000004
Hospital Revenue Code 420
Min. Negotiated Rate $68.97
Max. Negotiated Rate $110.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $107.80
Rate for Payer: Altius Auto/Workers Compensation $105.60
Rate for Payer: Altius Commercial $105.60
Rate for Payer: Beech Street Commercial $107.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $90.31
Rate for Payer: Cash Price $77.00
Rate for Payer: ChoiceCare Network Commercial $106.70
Rate for Payer: Cigna of WY Commercial $107.80
Rate for Payer: Entrust Commercial $104.50
Rate for Payer: First Choice Health Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $72.60
Rate for Payer: HealthUtah PPO $110.00
Rate for Payer: Idaho Integrated Healthcare Commercial $106.70
Rate for Payer: Multiplan Medicare/VA $68.97
Rate for Payer: One Health Plan of WY PPO $107.80
Rate for Payer: PacificSource Commercial $99.00
Rate for Payer: PHCS PPO $107.80
Rate for Payer: Three Rivers PPO $82.50
Rate for Payer: TriWest Veterans Administration $72.60
Rate for Payer: United Healthcare Commercial $95.70
Rate for Payer: United Healthcare Medicare $72.60
Rate for Payer: WINHealth Partners Commercial $104.50
Rate for Payer: Wise Provider Network Commercial $104.50
Service Code HCPCS 97755
Hospital Charge Code 4309775501
Hospital Revenue Code 430
Min. Negotiated Rate $112.86
Max. Negotiated Rate $180.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $176.40
Rate for Payer: Altius Auto/Workers Compensation $172.80
Rate for Payer: Altius Commercial $172.80
Rate for Payer: Beech Street Commercial $176.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $147.78
Rate for Payer: Cash Price $126.00
Rate for Payer: ChoiceCare Network Commercial $174.60
Rate for Payer: Cigna of WY Commercial $176.40
Rate for Payer: Entrust Commercial $171.00
Rate for Payer: First Choice Health Commercial $171.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $171.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $118.80
Rate for Payer: HealthUtah PPO $180.00
Rate for Payer: Idaho Integrated Healthcare Commercial $174.60
Rate for Payer: Multiplan Medicare/VA $112.86
Rate for Payer: One Health Plan of WY PPO $176.40
Rate for Payer: PacificSource Commercial $162.00
Rate for Payer: PHCS PPO $176.40
Rate for Payer: Three Rivers PPO $135.00
Rate for Payer: TriWest Veterans Administration $118.80
Rate for Payer: United Healthcare Commercial $156.60
Rate for Payer: United Healthcare Medicare $118.80
Rate for Payer: WINHealth Partners Commercial $171.00
Rate for Payer: Wise Provider Network Commercial $171.00