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Service Code HCPCS 97755
Hospital Charge Code 4309775501
Hospital Revenue Code 430
Min. Negotiated Rate $99.18
Max. Negotiated Rate $180.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $176.40
Rate for Payer: Aetna of WY Medicare $118.80
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 $104.40
Rate for Payer: HealthUtah PPO $180.00
Rate for Payer: Idaho Integrated Healthcare Commercial $174.60
Rate for Payer: Multiplan Medicare/VA $99.18
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 $104.40
Rate for Payer: United Healthcare Commercial $156.60
Rate for Payer: United Healthcare Medicare $104.40
Rate for Payer: WINHealth Partners Commercial $176.40
Rate for Payer: Wise Provider Network Commercial $171.00
Service Code HCPCS 97130
Hospital Charge Code 4309713001
Hospital Revenue Code 430
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
Service Code HCPCS 97130
Hospital Charge Code 4309713001
Hospital Revenue Code 430
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
Service Code HCPCS 97129
Hospital Charge Code 4309712901
Hospital Revenue Code 430
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 97129
Hospital Charge Code 4309712901
Hospital Revenue Code 430
Min. Negotiated Rate $60.61
Max. Negotiated Rate $110.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $107.80
Rate for Payer: Aetna of WY Medicare $72.60
Rate for Payer: Altius Auto/Workers Compensation $105.60
Rate for Payer: Altius Commercial $105.60
Rate for Payer: Beech Street Commercial $107.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $90.31
Rate for Payer: Cash Price $77.00
Rate for Payer: ChoiceCare Network Commercial $106.70
Rate for Payer: Cigna of WY Commercial $107.80
Rate for Payer: Entrust Commercial $104.50
Rate for Payer: First Choice Health Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $63.80
Rate for Payer: HealthUtah PPO $110.00
Rate for Payer: Idaho Integrated Healthcare Commercial $106.70
Rate for Payer: Multiplan Medicare/VA $60.61
Rate for Payer: One Health Plan of WY PPO $107.80
Rate for Payer: PacificSource Commercial $99.00
Rate for Payer: PHCS PPO $107.80
Rate for Payer: Three Rivers PPO $82.50
Rate for Payer: TriWest Veterans Administration $63.80
Rate for Payer: United Healthcare Commercial $95.70
Rate for Payer: United Healthcare Medicare $63.80
Rate for Payer: WINHealth Partners Commercial $107.80
Rate for Payer: Wise Provider Network Commercial $104.50
Service Code HCPCS G0283
Hospital Charge Code 430G028301
Hospital Revenue Code 430
Min. Negotiated Rate $68.88
Max. Negotiated Rate $125.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $122.50
Rate for Payer: Aetna of WY Medicare $82.50
Rate for Payer: Altius Auto/Workers Compensation $120.00
Rate for Payer: Altius Commercial $120.00
Rate for Payer: Beech Street Commercial $122.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $102.62
Rate for Payer: Cash Price $87.50
Rate for Payer: ChoiceCare Network Commercial $121.25
Rate for Payer: Cigna of WY Commercial $122.50
Rate for Payer: Entrust Commercial $118.75
Rate for Payer: First Choice Health Commercial $118.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $118.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $72.50
Rate for Payer: HealthUtah PPO $125.00
Rate for Payer: Idaho Integrated Healthcare Commercial $121.25
Rate for Payer: Multiplan Medicare/VA $68.88
Rate for Payer: One Health Plan of WY PPO $122.50
Rate for Payer: PacificSource Commercial $112.50
Rate for Payer: PHCS PPO $122.50
Rate for Payer: Three Rivers PPO $93.75
Rate for Payer: TriWest Veterans Administration $72.50
Rate for Payer: United Healthcare Commercial $108.75
Rate for Payer: United Healthcare Medicare $72.50
Rate for Payer: WINHealth Partners Commercial $122.50
Rate for Payer: Wise Provider Network Commercial $118.75
Service Code HCPCS G0283
Hospital Charge Code 430G028301
Hospital Revenue Code 430
Min. Negotiated Rate $78.38
Max. Negotiated Rate $125.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $122.50
Rate for Payer: Altius Auto/Workers Compensation $120.00
Rate for Payer: Altius Commercial $120.00
Rate for Payer: Beech Street Commercial $122.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $102.62
Rate for Payer: Cash Price $87.50
Rate for Payer: ChoiceCare Network Commercial $121.25
Rate for Payer: Cigna of WY Commercial $122.50
Rate for Payer: Entrust Commercial $118.75
Rate for Payer: First Choice Health Commercial $118.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $118.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $82.50
Rate for Payer: HealthUtah PPO $125.00
Rate for Payer: Idaho Integrated Healthcare Commercial $121.25
Rate for Payer: Multiplan Medicare/VA $78.38
Rate for Payer: One Health Plan of WY PPO $122.50
Rate for Payer: PacificSource Commercial $112.50
Rate for Payer: PHCS PPO $122.50
Rate for Payer: Three Rivers PPO $93.75
Rate for Payer: TriWest Veterans Administration $82.50
Rate for Payer: United Healthcare Commercial $108.75
Rate for Payer: United Healthcare Medicare $82.50
Rate for Payer: WINHealth Partners Commercial $118.75
Rate for Payer: Wise Provider Network Commercial $118.75
Service Code HCPCS 97032
Hospital Charge Code 4309703201
Hospital Revenue Code 430
Min. Negotiated Rate $46.84
Max. Negotiated Rate $85.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $83.30
Rate for Payer: Aetna of WY Medicare $56.10
Rate for Payer: Altius Auto/Workers Compensation $81.60
Rate for Payer: Altius Commercial $81.60
Rate for Payer: Beech Street Commercial $83.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $69.78
Rate for Payer: Cash Price $59.50
Rate for Payer: ChoiceCare Network Commercial $82.45
Rate for Payer: Cigna of WY Commercial $83.30
Rate for Payer: Entrust Commercial $80.75
Rate for Payer: First Choice Health Commercial $80.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $80.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $49.30
Rate for Payer: HealthUtah PPO $85.00
Rate for Payer: Idaho Integrated Healthcare Commercial $82.45
Rate for Payer: Multiplan Medicare/VA $46.84
Rate for Payer: One Health Plan of WY PPO $83.30
Rate for Payer: PacificSource Commercial $76.50
Rate for Payer: PHCS PPO $83.30
Rate for Payer: Three Rivers PPO $63.75
Rate for Payer: TriWest Veterans Administration $49.30
Rate for Payer: United Healthcare Commercial $73.95
Rate for Payer: United Healthcare Medicare $49.30
Rate for Payer: WINHealth Partners Commercial $83.30
Rate for Payer: Wise Provider Network Commercial $80.75
Service Code HCPCS 97032
Hospital Charge Code 4309703201
Hospital Revenue Code 430
Min. Negotiated Rate $53.30
Max. Negotiated Rate $85.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $83.30
Rate for Payer: Altius Auto/Workers Compensation $81.60
Rate for Payer: Altius Commercial $81.60
Rate for Payer: Beech Street Commercial $83.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $69.78
Rate for Payer: Cash Price $59.50
Rate for Payer: ChoiceCare Network Commercial $82.45
Rate for Payer: Cigna of WY Commercial $83.30
Rate for Payer: Entrust Commercial $80.75
Rate for Payer: First Choice Health Commercial $80.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $80.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $56.10
Rate for Payer: HealthUtah PPO $85.00
Rate for Payer: Idaho Integrated Healthcare Commercial $82.45
Rate for Payer: Multiplan Medicare/VA $53.30
Rate for Payer: One Health Plan of WY PPO $83.30
Rate for Payer: PacificSource Commercial $76.50
Rate for Payer: PHCS PPO $83.30
Rate for Payer: Three Rivers PPO $63.75
Rate for Payer: TriWest Veterans Administration $56.10
Rate for Payer: United Healthcare Commercial $73.95
Rate for Payer: United Healthcare Medicare $56.10
Rate for Payer: WINHealth Partners Commercial $80.75
Rate for Payer: Wise Provider Network Commercial $80.75
Service Code HCPCS 97033
Hospital Charge Code 4309703301
Hospital Revenue Code 430
Min. Negotiated Rate $128.54
Max. Negotiated Rate $205.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $200.90
Rate for Payer: Altius Auto/Workers Compensation $196.80
Rate for Payer: Altius Commercial $196.80
Rate for Payer: Beech Street Commercial $200.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $168.30
Rate for Payer: Cash Price $143.50
Rate for Payer: ChoiceCare Network Commercial $198.85
Rate for Payer: Cigna of WY Commercial $200.90
Rate for Payer: Entrust Commercial $194.75
Rate for Payer: First Choice Health Commercial $194.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $194.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $135.30
Rate for Payer: HealthUtah PPO $205.00
Rate for Payer: Idaho Integrated Healthcare Commercial $198.85
Rate for Payer: Multiplan Medicare/VA $128.54
Rate for Payer: One Health Plan of WY PPO $200.90
Rate for Payer: PacificSource Commercial $184.50
Rate for Payer: PHCS PPO $200.90
Rate for Payer: Three Rivers PPO $153.75
Rate for Payer: TriWest Veterans Administration $135.30
Rate for Payer: United Healthcare Commercial $178.35
Rate for Payer: United Healthcare Medicare $135.30
Rate for Payer: WINHealth Partners Commercial $194.75
Rate for Payer: Wise Provider Network Commercial $194.75
Service Code HCPCS 97033
Hospital Charge Code 4309703301
Hospital Revenue Code 430
Min. Negotiated Rate $112.96
Max. Negotiated Rate $205.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $200.90
Rate for Payer: Aetna of WY Medicare $135.30
Rate for Payer: Altius Auto/Workers Compensation $196.80
Rate for Payer: Altius Commercial $196.80
Rate for Payer: Beech Street Commercial $200.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $168.30
Rate for Payer: Cash Price $143.50
Rate for Payer: ChoiceCare Network Commercial $198.85
Rate for Payer: Cigna of WY Commercial $200.90
Rate for Payer: Entrust Commercial $194.75
Rate for Payer: First Choice Health Commercial $194.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $194.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $118.90
Rate for Payer: HealthUtah PPO $205.00
Rate for Payer: Idaho Integrated Healthcare Commercial $198.85
Rate for Payer: Multiplan Medicare/VA $112.96
Rate for Payer: One Health Plan of WY PPO $200.90
Rate for Payer: PacificSource Commercial $184.50
Rate for Payer: PHCS PPO $200.90
Rate for Payer: Three Rivers PPO $153.75
Rate for Payer: TriWest Veterans Administration $118.90
Rate for Payer: United Healthcare Commercial $178.35
Rate for Payer: United Healthcare Medicare $118.90
Rate for Payer: WINHealth Partners Commercial $200.90
Rate for Payer: Wise Provider Network Commercial $194.75
Service Code HCPCS 97014
Hospital Charge Code 4309701401
Hospital Revenue Code 430
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
Service Code HCPCS 97014
Hospital Charge Code 4309701401
Hospital Revenue Code 430
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
Service Code HCPCS 97140
Hospital Charge Code 4309714001
Hospital Revenue Code 430
Min. Negotiated Rate $99.18
Max. Negotiated Rate $180.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $176.40
Rate for Payer: Aetna of WY Medicare $118.80
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 $104.40
Rate for Payer: HealthUtah PPO $180.00
Rate for Payer: Idaho Integrated Healthcare Commercial $174.60
Rate for Payer: Multiplan Medicare/VA $99.18
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 $104.40
Rate for Payer: United Healthcare Commercial $156.60
Rate for Payer: United Healthcare Medicare $104.40
Rate for Payer: WINHealth Partners Commercial $176.40
Rate for Payer: Wise Provider Network Commercial $171.00
Service Code HCPCS 97140
Hospital Charge Code 4309714001
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
Service Code HCPCS 97124
Hospital Charge Code 4309712401
Hospital Revenue Code 430
Min. Negotiated Rate $87.78
Max. Negotiated Rate $140.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $137.20
Rate for Payer: Altius Auto/Workers Compensation $134.40
Rate for Payer: Altius Commercial $134.40
Rate for Payer: Beech Street Commercial $137.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $114.94
Rate for Payer: Cash Price $98.00
Rate for Payer: ChoiceCare Network Commercial $135.80
Rate for Payer: Cigna of WY Commercial $137.20
Rate for Payer: Entrust Commercial $133.00
Rate for Payer: First Choice Health Commercial $133.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $133.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $92.40
Rate for Payer: HealthUtah PPO $140.00
Rate for Payer: Idaho Integrated Healthcare Commercial $135.80
Rate for Payer: Multiplan Medicare/VA $87.78
Rate for Payer: One Health Plan of WY PPO $137.20
Rate for Payer: PacificSource Commercial $126.00
Rate for Payer: PHCS PPO $137.20
Rate for Payer: Three Rivers PPO $105.00
Rate for Payer: TriWest Veterans Administration $92.40
Rate for Payer: United Healthcare Commercial $121.80
Rate for Payer: United Healthcare Medicare $92.40
Rate for Payer: WINHealth Partners Commercial $133.00
Rate for Payer: Wise Provider Network Commercial $133.00
Service Code HCPCS 97124
Hospital Charge Code 4309712401
Hospital Revenue Code 430
Min. Negotiated Rate $77.14
Max. Negotiated Rate $140.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $137.20
Rate for Payer: Aetna of WY Medicare $92.40
Rate for Payer: Altius Auto/Workers Compensation $134.40
Rate for Payer: Altius Commercial $134.40
Rate for Payer: Beech Street Commercial $137.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $114.94
Rate for Payer: Cash Price $98.00
Rate for Payer: ChoiceCare Network Commercial $135.80
Rate for Payer: Cigna of WY Commercial $137.20
Rate for Payer: Entrust Commercial $133.00
Rate for Payer: First Choice Health Commercial $133.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $133.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $81.20
Rate for Payer: HealthUtah PPO $140.00
Rate for Payer: Idaho Integrated Healthcare Commercial $135.80
Rate for Payer: Multiplan Medicare/VA $77.14
Rate for Payer: One Health Plan of WY PPO $137.20
Rate for Payer: PacificSource Commercial $126.00
Rate for Payer: PHCS PPO $137.20
Rate for Payer: Three Rivers PPO $105.00
Rate for Payer: TriWest Veterans Administration $81.20
Rate for Payer: United Healthcare Commercial $121.80
Rate for Payer: United Healthcare Medicare $81.20
Rate for Payer: WINHealth Partners Commercial $137.20
Rate for Payer: Wise Provider Network Commercial $133.00
Service Code HCPCS 97112
Hospital Charge Code 4309711201
Hospital Revenue Code 430
Min. Negotiated Rate $143.26
Max. Negotiated Rate $260.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $254.80
Rate for Payer: Aetna of WY Medicare $171.60
Rate for Payer: Altius Auto/Workers Compensation $249.60
Rate for Payer: Altius Commercial $249.60
Rate for Payer: Beech Street Commercial $254.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $213.46
Rate for Payer: Cash Price $182.00
Rate for Payer: ChoiceCare Network Commercial $252.20
Rate for Payer: Cigna of WY Commercial $254.80
Rate for Payer: Entrust Commercial $247.00
Rate for Payer: First Choice Health Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $150.80
Rate for Payer: HealthUtah PPO $260.00
Rate for Payer: Idaho Integrated Healthcare Commercial $252.20
Rate for Payer: Multiplan Medicare/VA $143.26
Rate for Payer: One Health Plan of WY PPO $254.80
Rate for Payer: PacificSource Commercial $234.00
Rate for Payer: PHCS PPO $254.80
Rate for Payer: Three Rivers PPO $195.00
Rate for Payer: TriWest Veterans Administration $150.80
Rate for Payer: United Healthcare Commercial $226.20
Rate for Payer: United Healthcare Medicare $150.80
Rate for Payer: WINHealth Partners Commercial $254.80
Rate for Payer: Wise Provider Network Commercial $247.00
Service Code HCPCS 97112
Hospital Charge Code 4309711201
Hospital Revenue Code 430
Min. Negotiated Rate $163.02
Max. Negotiated Rate $260.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $254.80
Rate for Payer: Altius Auto/Workers Compensation $249.60
Rate for Payer: Altius Commercial $249.60
Rate for Payer: Beech Street Commercial $254.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $213.46
Rate for Payer: Cash Price $182.00
Rate for Payer: ChoiceCare Network Commercial $252.20
Rate for Payer: Cigna of WY Commercial $254.80
Rate for Payer: Entrust Commercial $247.00
Rate for Payer: First Choice Health Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $171.60
Rate for Payer: HealthUtah PPO $260.00
Rate for Payer: Idaho Integrated Healthcare Commercial $252.20
Rate for Payer: Multiplan Medicare/VA $163.02
Rate for Payer: One Health Plan of WY PPO $254.80
Rate for Payer: PacificSource Commercial $234.00
Rate for Payer: PHCS PPO $254.80
Rate for Payer: Three Rivers PPO $195.00
Rate for Payer: TriWest Veterans Administration $171.60
Rate for Payer: United Healthcare Commercial $226.20
Rate for Payer: United Healthcare Medicare $171.60
Rate for Payer: WINHealth Partners Commercial $247.00
Rate for Payer: Wise Provider Network Commercial $247.00
Service Code HCPCS 97167
Hospital Charge Code 4349716701
Hospital Revenue Code 434
Min. Negotiated Rate $326.04
Max. Negotiated Rate $520.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $509.60
Rate for Payer: Altius Auto/Workers Compensation $499.20
Rate for Payer: Altius Commercial $499.20
Rate for Payer: Beech Street Commercial $509.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $426.92
Rate for Payer: Cash Price $364.00
Rate for Payer: ChoiceCare Network Commercial $504.40
Rate for Payer: Cigna of WY Commercial $509.60
Rate for Payer: Entrust Commercial $494.00
Rate for Payer: First Choice Health Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $343.20
Rate for Payer: HealthUtah PPO $520.00
Rate for Payer: Idaho Integrated Healthcare Commercial $504.40
Rate for Payer: Multiplan Medicare/VA $326.04
Rate for Payer: One Health Plan of WY PPO $509.60
Rate for Payer: PacificSource Commercial $468.00
Rate for Payer: PHCS PPO $509.60
Rate for Payer: Three Rivers PPO $390.00
Rate for Payer: TriWest Veterans Administration $343.20
Rate for Payer: United Healthcare Commercial $452.40
Rate for Payer: United Healthcare Medicare $343.20
Rate for Payer: WINHealth Partners Commercial $494.00
Rate for Payer: Wise Provider Network Commercial $494.00
Service Code HCPCS 97167
Hospital Charge Code 4349716701
Hospital Revenue Code 434
Min. Negotiated Rate $286.52
Max. Negotiated Rate $520.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $509.60
Rate for Payer: Aetna of WY Medicare $343.20
Rate for Payer: Altius Auto/Workers Compensation $499.20
Rate for Payer: Altius Commercial $499.20
Rate for Payer: Beech Street Commercial $509.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $426.92
Rate for Payer: Cash Price $364.00
Rate for Payer: ChoiceCare Network Commercial $504.40
Rate for Payer: Cigna of WY Commercial $509.60
Rate for Payer: Entrust Commercial $494.00
Rate for Payer: First Choice Health Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $301.60
Rate for Payer: HealthUtah PPO $520.00
Rate for Payer: Idaho Integrated Healthcare Commercial $504.40
Rate for Payer: Multiplan Medicare/VA $286.52
Rate for Payer: One Health Plan of WY PPO $509.60
Rate for Payer: PacificSource Commercial $468.00
Rate for Payer: PHCS PPO $509.60
Rate for Payer: Three Rivers PPO $390.00
Rate for Payer: TriWest Veterans Administration $301.60
Rate for Payer: United Healthcare Commercial $452.40
Rate for Payer: United Healthcare Medicare $301.60
Rate for Payer: WINHealth Partners Commercial $509.60
Rate for Payer: Wise Provider Network Commercial $494.00
Service Code HCPCS 97165
Hospital Charge Code 4349716501
Hospital Revenue Code 434
Min. Negotiated Rate $191.24
Max. Negotiated Rate $305.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $298.90
Rate for Payer: Altius Auto/Workers Compensation $292.80
Rate for Payer: Altius Commercial $292.80
Rate for Payer: Beech Street Commercial $298.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $250.40
Rate for Payer: Cash Price $213.50
Rate for Payer: ChoiceCare Network Commercial $295.85
Rate for Payer: Cigna of WY Commercial $298.90
Rate for Payer: Entrust Commercial $289.75
Rate for Payer: First Choice Health Commercial $289.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $289.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $201.30
Rate for Payer: HealthUtah PPO $305.00
Rate for Payer: Idaho Integrated Healthcare Commercial $295.85
Rate for Payer: Multiplan Medicare/VA $191.24
Rate for Payer: One Health Plan of WY PPO $298.90
Rate for Payer: PacificSource Commercial $274.50
Rate for Payer: PHCS PPO $298.90
Rate for Payer: Three Rivers PPO $228.75
Rate for Payer: TriWest Veterans Administration $201.30
Rate for Payer: United Healthcare Commercial $265.35
Rate for Payer: United Healthcare Medicare $201.30
Rate for Payer: WINHealth Partners Commercial $289.75
Rate for Payer: Wise Provider Network Commercial $289.75
Service Code HCPCS 97165
Hospital Charge Code 4349716501
Hospital Revenue Code 434
Min. Negotiated Rate $168.06
Max. Negotiated Rate $305.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $298.90
Rate for Payer: Aetna of WY Medicare $201.30
Rate for Payer: Altius Auto/Workers Compensation $292.80
Rate for Payer: Altius Commercial $292.80
Rate for Payer: Beech Street Commercial $298.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $250.40
Rate for Payer: Cash Price $213.50
Rate for Payer: ChoiceCare Network Commercial $295.85
Rate for Payer: Cigna of WY Commercial $298.90
Rate for Payer: Entrust Commercial $289.75
Rate for Payer: First Choice Health Commercial $289.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $289.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $176.90
Rate for Payer: HealthUtah PPO $305.00
Rate for Payer: Idaho Integrated Healthcare Commercial $295.85
Rate for Payer: Multiplan Medicare/VA $168.06
Rate for Payer: One Health Plan of WY PPO $298.90
Rate for Payer: PacificSource Commercial $274.50
Rate for Payer: PHCS PPO $298.90
Rate for Payer: Three Rivers PPO $228.75
Rate for Payer: TriWest Veterans Administration $176.90
Rate for Payer: United Healthcare Commercial $265.35
Rate for Payer: United Healthcare Medicare $176.90
Rate for Payer: WINHealth Partners Commercial $298.90
Rate for Payer: Wise Provider Network Commercial $289.75
Service Code HCPCS 97166
Hospital Charge Code 4349716601
Hospital Revenue Code 434
Min. Negotiated Rate $322.90
Max. Negotiated Rate $515.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $504.70
Rate for Payer: Altius Auto/Workers Compensation $494.40
Rate for Payer: Altius Commercial $494.40
Rate for Payer: Beech Street Commercial $504.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $422.82
Rate for Payer: Cash Price $360.50
Rate for Payer: ChoiceCare Network Commercial $499.55
Rate for Payer: Cigna of WY Commercial $504.70
Rate for Payer: Entrust Commercial $489.25
Rate for Payer: First Choice Health Commercial $489.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $489.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $339.90
Rate for Payer: HealthUtah PPO $515.00
Rate for Payer: Idaho Integrated Healthcare Commercial $499.55
Rate for Payer: Multiplan Medicare/VA $322.90
Rate for Payer: One Health Plan of WY PPO $504.70
Rate for Payer: PacificSource Commercial $463.50
Rate for Payer: PHCS PPO $504.70
Rate for Payer: Three Rivers PPO $386.25
Rate for Payer: TriWest Veterans Administration $339.90
Rate for Payer: United Healthcare Commercial $448.05
Rate for Payer: United Healthcare Medicare $339.90
Rate for Payer: WINHealth Partners Commercial $489.25
Rate for Payer: Wise Provider Network Commercial $489.25
Service Code HCPCS 97166
Hospital Charge Code 4349716601
Hospital Revenue Code 434
Min. Negotiated Rate $283.76
Max. Negotiated Rate $515.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $504.70
Rate for Payer: Aetna of WY Medicare $339.90
Rate for Payer: Altius Auto/Workers Compensation $494.40
Rate for Payer: Altius Commercial $494.40
Rate for Payer: Beech Street Commercial $504.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $422.82
Rate for Payer: Cash Price $360.50
Rate for Payer: ChoiceCare Network Commercial $499.55
Rate for Payer: Cigna of WY Commercial $504.70
Rate for Payer: Entrust Commercial $489.25
Rate for Payer: First Choice Health Commercial $489.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $489.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $298.70
Rate for Payer: HealthUtah PPO $515.00
Rate for Payer: Idaho Integrated Healthcare Commercial $499.55
Rate for Payer: Multiplan Medicare/VA $283.76
Rate for Payer: One Health Plan of WY PPO $504.70
Rate for Payer: PacificSource Commercial $463.50
Rate for Payer: PHCS PPO $504.70
Rate for Payer: Three Rivers PPO $386.25
Rate for Payer: TriWest Veterans Administration $298.70
Rate for Payer: United Healthcare Commercial $448.05
Rate for Payer: United Healthcare Medicare $298.70
Rate for Payer: WINHealth Partners Commercial $504.70
Rate for Payer: Wise Provider Network Commercial $489.25