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Service Code HCPCS 97168
Hospital Charge Code 4349716801
Hospital Revenue Code 434
Min. Negotiated Rate $157.04
Max. Negotiated Rate $285.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $279.30
Rate for Payer: Aetna of WY Medicare $188.10
Rate for Payer: Altius Auto/Workers Compensation $273.60
Rate for Payer: Altius Commercial $273.60
Rate for Payer: Beech Street Commercial $279.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $233.98
Rate for Payer: Cash Price $199.50
Rate for Payer: ChoiceCare Network Commercial $276.45
Rate for Payer: Cigna of WY Commercial $279.30
Rate for Payer: Entrust Commercial $270.75
Rate for Payer: First Choice Health Commercial $270.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $270.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $165.30
Rate for Payer: HealthUtah PPO $285.00
Rate for Payer: Idaho Integrated Healthcare Commercial $276.45
Rate for Payer: Multiplan Medicare/VA $157.04
Rate for Payer: One Health Plan of WY PPO $279.30
Rate for Payer: PacificSource Commercial $256.50
Rate for Payer: PHCS PPO $279.30
Rate for Payer: Three Rivers PPO $213.75
Rate for Payer: TriWest Veterans Administration $165.30
Rate for Payer: United Healthcare Commercial $247.95
Rate for Payer: United Healthcare Medicare $165.30
Rate for Payer: WINHealth Partners Commercial $279.30
Rate for Payer: Wise Provider Network Commercial $270.75
Service Code HCPCS 97168
Hospital Charge Code 4349716801
Hospital Revenue Code 434
Min. Negotiated Rate $178.70
Max. Negotiated Rate $285.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $279.30
Rate for Payer: Altius Auto/Workers Compensation $273.60
Rate for Payer: Altius Commercial $273.60
Rate for Payer: Beech Street Commercial $279.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $233.98
Rate for Payer: Cash Price $199.50
Rate for Payer: ChoiceCare Network Commercial $276.45
Rate for Payer: Cigna of WY Commercial $279.30
Rate for Payer: Entrust Commercial $270.75
Rate for Payer: First Choice Health Commercial $270.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $270.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $188.10
Rate for Payer: HealthUtah PPO $285.00
Rate for Payer: Idaho Integrated Healthcare Commercial $276.45
Rate for Payer: Multiplan Medicare/VA $178.70
Rate for Payer: One Health Plan of WY PPO $279.30
Rate for Payer: PacificSource Commercial $256.50
Rate for Payer: PHCS PPO $279.30
Rate for Payer: Three Rivers PPO $213.75
Rate for Payer: TriWest Veterans Administration $188.10
Rate for Payer: United Healthcare Commercial $247.95
Rate for Payer: United Healthcare Medicare $188.10
Rate for Payer: WINHealth Partners Commercial $270.75
Rate for Payer: Wise Provider Network Commercial $270.75
Service Code HCPCS 97760
Hospital Charge Code 4309776001
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 97760
Hospital Charge Code 4309776001
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 97018
Hospital Charge Code 4309701801
Hospital Revenue Code 430
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
Service Code HCPCS 97018
Hospital Charge Code 4309701801
Hospital Revenue Code 430
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
Service Code HCPCS 97750
Hospital Charge Code 4309775001
Hospital Revenue Code 430
Min. Negotiated Rate $88.16
Max. Negotiated Rate $160.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $156.80
Rate for Payer: Aetna of WY Medicare $105.60
Rate for Payer: Altius Auto/Workers Compensation $153.60
Rate for Payer: Altius Commercial $153.60
Rate for Payer: Beech Street Commercial $156.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $131.36
Rate for Payer: Cash Price $112.00
Rate for Payer: ChoiceCare Network Commercial $155.20
Rate for Payer: Cigna of WY Commercial $156.80
Rate for Payer: Entrust Commercial $152.00
Rate for Payer: First Choice Health Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $92.80
Rate for Payer: HealthUtah PPO $160.00
Rate for Payer: Idaho Integrated Healthcare Commercial $155.20
Rate for Payer: Multiplan Medicare/VA $88.16
Rate for Payer: One Health Plan of WY PPO $156.80
Rate for Payer: PacificSource Commercial $144.00
Rate for Payer: PHCS PPO $156.80
Rate for Payer: Three Rivers PPO $120.00
Rate for Payer: TriWest Veterans Administration $92.80
Rate for Payer: United Healthcare Commercial $139.20
Rate for Payer: United Healthcare Medicare $92.80
Rate for Payer: WINHealth Partners Commercial $156.80
Rate for Payer: Wise Provider Network Commercial $152.00
Service Code HCPCS 97750
Hospital Charge Code 4309775001
Hospital Revenue Code 430
Min. Negotiated Rate $100.32
Max. Negotiated Rate $160.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $156.80
Rate for Payer: Altius Auto/Workers Compensation $153.60
Rate for Payer: Altius Commercial $153.60
Rate for Payer: Beech Street Commercial $156.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $131.36
Rate for Payer: Cash Price $112.00
Rate for Payer: ChoiceCare Network Commercial $155.20
Rate for Payer: Cigna of WY Commercial $156.80
Rate for Payer: Entrust Commercial $152.00
Rate for Payer: First Choice Health Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $105.60
Rate for Payer: HealthUtah PPO $160.00
Rate for Payer: Idaho Integrated Healthcare Commercial $155.20
Rate for Payer: Multiplan Medicare/VA $100.32
Rate for Payer: One Health Plan of WY PPO $156.80
Rate for Payer: PacificSource Commercial $144.00
Rate for Payer: PHCS PPO $156.80
Rate for Payer: Three Rivers PPO $120.00
Rate for Payer: TriWest Veterans Administration $105.60
Rate for Payer: United Healthcare Commercial $139.20
Rate for Payer: United Healthcare Medicare $105.60
Rate for Payer: WINHealth Partners Commercial $152.00
Rate for Payer: Wise Provider Network Commercial $152.00
Service Code HCPCS 97535
Hospital Charge Code 4309753501
Hospital Revenue Code 430
Min. Negotiated Rate $116.00
Max. Negotiated Rate $185.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $181.30
Rate for Payer: Altius Auto/Workers Compensation $177.60
Rate for Payer: Altius Commercial $177.60
Rate for Payer: Beech Street Commercial $181.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $151.88
Rate for Payer: Cash Price $129.50
Rate for Payer: ChoiceCare Network Commercial $179.45
Rate for Payer: Cigna of WY Commercial $181.30
Rate for Payer: Entrust Commercial $175.75
Rate for Payer: First Choice Health Commercial $175.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $175.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $122.10
Rate for Payer: HealthUtah PPO $185.00
Rate for Payer: Idaho Integrated Healthcare Commercial $179.45
Rate for Payer: Multiplan Medicare/VA $116.00
Rate for Payer: One Health Plan of WY PPO $181.30
Rate for Payer: PacificSource Commercial $166.50
Rate for Payer: PHCS PPO $181.30
Rate for Payer: Three Rivers PPO $138.75
Rate for Payer: TriWest Veterans Administration $122.10
Rate for Payer: United Healthcare Commercial $160.95
Rate for Payer: United Healthcare Medicare $122.10
Rate for Payer: WINHealth Partners Commercial $175.75
Rate for Payer: Wise Provider Network Commercial $175.75
Service Code HCPCS 97535
Hospital Charge Code 4309753501
Hospital Revenue Code 430
Min. Negotiated Rate $101.94
Max. Negotiated Rate $185.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $181.30
Rate for Payer: Aetna of WY Medicare $122.10
Rate for Payer: Altius Auto/Workers Compensation $177.60
Rate for Payer: Altius Commercial $177.60
Rate for Payer: Beech Street Commercial $181.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $151.88
Rate for Payer: Cash Price $129.50
Rate for Payer: ChoiceCare Network Commercial $179.45
Rate for Payer: Cigna of WY Commercial $181.30
Rate for Payer: Entrust Commercial $175.75
Rate for Payer: First Choice Health Commercial $175.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $175.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $107.30
Rate for Payer: HealthUtah PPO $185.00
Rate for Payer: Idaho Integrated Healthcare Commercial $179.45
Rate for Payer: Multiplan Medicare/VA $101.94
Rate for Payer: One Health Plan of WY PPO $181.30
Rate for Payer: PacificSource Commercial $166.50
Rate for Payer: PHCS PPO $181.30
Rate for Payer: Three Rivers PPO $138.75
Rate for Payer: TriWest Veterans Administration $107.30
Rate for Payer: United Healthcare Commercial $160.95
Rate for Payer: United Healthcare Medicare $107.30
Rate for Payer: WINHealth Partners Commercial $181.30
Rate for Payer: Wise Provider Network Commercial $175.75
Service Code HCPCS 98960
Hospital Charge Code 4309896001
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 98960
Hospital Charge Code 4309896001
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 97533
Hospital Charge Code 4309753301
Hospital Revenue Code 430
Min. Negotiated Rate $81.51
Max. Negotiated Rate $130.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $127.40
Rate for Payer: Altius Auto/Workers Compensation $124.80
Rate for Payer: Altius Commercial $124.80
Rate for Payer: Beech Street Commercial $127.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $106.73
Rate for Payer: Cash Price $91.00
Rate for Payer: ChoiceCare Network Commercial $126.10
Rate for Payer: Cigna of WY Commercial $127.40
Rate for Payer: Entrust Commercial $123.50
Rate for Payer: First Choice Health Commercial $123.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $123.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $85.80
Rate for Payer: HealthUtah PPO $130.00
Rate for Payer: Idaho Integrated Healthcare Commercial $126.10
Rate for Payer: Multiplan Medicare/VA $81.51
Rate for Payer: One Health Plan of WY PPO $127.40
Rate for Payer: PacificSource Commercial $117.00
Rate for Payer: PHCS PPO $127.40
Rate for Payer: Three Rivers PPO $97.50
Rate for Payer: TriWest Veterans Administration $85.80
Rate for Payer: United Healthcare Commercial $113.10
Rate for Payer: United Healthcare Medicare $85.80
Rate for Payer: WINHealth Partners Commercial $123.50
Rate for Payer: Wise Provider Network Commercial $123.50
Service Code HCPCS 97533
Hospital Charge Code 4309753301
Hospital Revenue Code 430
Min. Negotiated Rate $71.63
Max. Negotiated Rate $130.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $127.40
Rate for Payer: Aetna of WY Medicare $85.80
Rate for Payer: Altius Auto/Workers Compensation $124.80
Rate for Payer: Altius Commercial $124.80
Rate for Payer: Beech Street Commercial $127.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $106.73
Rate for Payer: Cash Price $91.00
Rate for Payer: ChoiceCare Network Commercial $126.10
Rate for Payer: Cigna of WY Commercial $127.40
Rate for Payer: Entrust Commercial $123.50
Rate for Payer: First Choice Health Commercial $123.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $123.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $75.40
Rate for Payer: HealthUtah PPO $130.00
Rate for Payer: Idaho Integrated Healthcare Commercial $126.10
Rate for Payer: Multiplan Medicare/VA $71.63
Rate for Payer: One Health Plan of WY PPO $127.40
Rate for Payer: PacificSource Commercial $117.00
Rate for Payer: PHCS PPO $127.40
Rate for Payer: Three Rivers PPO $97.50
Rate for Payer: TriWest Veterans Administration $75.40
Rate for Payer: United Healthcare Commercial $113.10
Rate for Payer: United Healthcare Medicare $75.40
Rate for Payer: WINHealth Partners Commercial $127.40
Rate for Payer: Wise Provider Network Commercial $123.50
Service Code HCPCS 97530
Hospital Charge Code 4309753001
Hospital Revenue Code 430
Min. Negotiated Rate $132.24
Max. Negotiated Rate $240.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $235.20
Rate for Payer: Aetna of WY Medicare $158.40
Rate for Payer: Altius Auto/Workers Compensation $230.40
Rate for Payer: Altius Commercial $230.40
Rate for Payer: Beech Street Commercial $235.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $197.04
Rate for Payer: Cash Price $168.00
Rate for Payer: ChoiceCare Network Commercial $232.80
Rate for Payer: Cigna of WY Commercial $235.20
Rate for Payer: Entrust Commercial $228.00
Rate for Payer: First Choice Health Commercial $228.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $228.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $139.20
Rate for Payer: HealthUtah PPO $240.00
Rate for Payer: Idaho Integrated Healthcare Commercial $232.80
Rate for Payer: Multiplan Medicare/VA $132.24
Rate for Payer: One Health Plan of WY PPO $235.20
Rate for Payer: PacificSource Commercial $216.00
Rate for Payer: PHCS PPO $235.20
Rate for Payer: Three Rivers PPO $180.00
Rate for Payer: TriWest Veterans Administration $139.20
Rate for Payer: United Healthcare Commercial $208.80
Rate for Payer: United Healthcare Medicare $139.20
Rate for Payer: WINHealth Partners Commercial $235.20
Rate for Payer: Wise Provider Network Commercial $228.00
Service Code HCPCS 97530
Hospital Charge Code 4309753001
Hospital Revenue Code 430
Min. Negotiated Rate $150.48
Max. Negotiated Rate $240.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $235.20
Rate for Payer: Altius Auto/Workers Compensation $230.40
Rate for Payer: Altius Commercial $230.40
Rate for Payer: Beech Street Commercial $235.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $197.04
Rate for Payer: Cash Price $168.00
Rate for Payer: ChoiceCare Network Commercial $232.80
Rate for Payer: Cigna of WY Commercial $235.20
Rate for Payer: Entrust Commercial $228.00
Rate for Payer: First Choice Health Commercial $228.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $228.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $158.40
Rate for Payer: HealthUtah PPO $240.00
Rate for Payer: Idaho Integrated Healthcare Commercial $232.80
Rate for Payer: Multiplan Medicare/VA $150.48
Rate for Payer: One Health Plan of WY PPO $235.20
Rate for Payer: PacificSource Commercial $216.00
Rate for Payer: PHCS PPO $235.20
Rate for Payer: Three Rivers PPO $180.00
Rate for Payer: TriWest Veterans Administration $158.40
Rate for Payer: United Healthcare Commercial $208.80
Rate for Payer: United Healthcare Medicare $158.40
Rate for Payer: WINHealth Partners Commercial $228.00
Rate for Payer: Wise Provider Network Commercial $228.00
Service Code HCPCS 97110
Hospital Charge Code 4309711001
Hospital Revenue Code 430
Min. Negotiated Rate $134.80
Max. Negotiated Rate $215.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $210.70
Rate for Payer: Altius Auto/Workers Compensation $206.40
Rate for Payer: Altius Commercial $206.40
Rate for Payer: Beech Street Commercial $210.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $176.52
Rate for Payer: Cash Price $150.50
Rate for Payer: ChoiceCare Network Commercial $208.55
Rate for Payer: Cigna of WY Commercial $210.70
Rate for Payer: Entrust Commercial $204.25
Rate for Payer: First Choice Health Commercial $204.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $204.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $141.90
Rate for Payer: HealthUtah PPO $215.00
Rate for Payer: Idaho Integrated Healthcare Commercial $208.55
Rate for Payer: Multiplan Medicare/VA $134.80
Rate for Payer: One Health Plan of WY PPO $210.70
Rate for Payer: PacificSource Commercial $193.50
Rate for Payer: PHCS PPO $210.70
Rate for Payer: Three Rivers PPO $161.25
Rate for Payer: TriWest Veterans Administration $141.90
Rate for Payer: United Healthcare Commercial $187.05
Rate for Payer: United Healthcare Medicare $141.90
Rate for Payer: WINHealth Partners Commercial $204.25
Rate for Payer: Wise Provider Network Commercial $204.25
Service Code HCPCS 97110
Hospital Charge Code 4309711001
Hospital Revenue Code 430
Min. Negotiated Rate $118.46
Max. Negotiated Rate $215.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $210.70
Rate for Payer: Aetna of WY Medicare $141.90
Rate for Payer: Altius Auto/Workers Compensation $206.40
Rate for Payer: Altius Commercial $206.40
Rate for Payer: Beech Street Commercial $210.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $176.52
Rate for Payer: Cash Price $150.50
Rate for Payer: ChoiceCare Network Commercial $208.55
Rate for Payer: Cigna of WY Commercial $210.70
Rate for Payer: Entrust Commercial $204.25
Rate for Payer: First Choice Health Commercial $204.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $204.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $124.70
Rate for Payer: HealthUtah PPO $215.00
Rate for Payer: Idaho Integrated Healthcare Commercial $208.55
Rate for Payer: Multiplan Medicare/VA $118.46
Rate for Payer: One Health Plan of WY PPO $210.70
Rate for Payer: PacificSource Commercial $193.50
Rate for Payer: PHCS PPO $210.70
Rate for Payer: Three Rivers PPO $161.25
Rate for Payer: TriWest Veterans Administration $124.70
Rate for Payer: United Healthcare Commercial $187.05
Rate for Payer: United Healthcare Medicare $124.70
Rate for Payer: WINHealth Partners Commercial $210.70
Rate for Payer: Wise Provider Network Commercial $204.25
Service Code HCPCS 97035
Hospital Charge Code 4309703501
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 97035
Hospital Charge Code 4309703501
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 97542
Hospital Charge Code 4309754201
Hospital Revenue Code 430
Min. Negotiated Rate $82.65
Max. Negotiated Rate $150.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.00
Rate for Payer: Aetna of WY Medicare $99.00
Rate for Payer: Altius Auto/Workers Compensation $144.00
Rate for Payer: Altius Commercial $144.00
Rate for Payer: Beech Street Commercial $147.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.15
Rate for Payer: Cash Price $105.00
Rate for Payer: ChoiceCare Network Commercial $145.50
Rate for Payer: Cigna of WY Commercial $147.00
Rate for Payer: Entrust Commercial $142.50
Rate for Payer: First Choice Health Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.00
Rate for Payer: HealthUtah PPO $150.00
Rate for Payer: Idaho Integrated Healthcare Commercial $145.50
Rate for Payer: Multiplan Medicare/VA $82.65
Rate for Payer: One Health Plan of WY PPO $147.00
Rate for Payer: PacificSource Commercial $135.00
Rate for Payer: PHCS PPO $147.00
Rate for Payer: Three Rivers PPO $112.50
Rate for Payer: TriWest Veterans Administration $87.00
Rate for Payer: United Healthcare Commercial $130.50
Rate for Payer: United Healthcare Medicare $87.00
Rate for Payer: WINHealth Partners Commercial $147.00
Rate for Payer: Wise Provider Network Commercial $142.50
Service Code HCPCS 97542
Hospital Charge Code 4309754201
Hospital Revenue Code 430
Min. Negotiated Rate $94.05
Max. Negotiated Rate $150.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.00
Rate for Payer: Altius Auto/Workers Compensation $144.00
Rate for Payer: Altius Commercial $144.00
Rate for Payer: Beech Street Commercial $147.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.15
Rate for Payer: Cash Price $105.00
Rate for Payer: ChoiceCare Network Commercial $145.50
Rate for Payer: Cigna of WY Commercial $147.00
Rate for Payer: Entrust Commercial $142.50
Rate for Payer: First Choice Health Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $99.00
Rate for Payer: HealthUtah PPO $150.00
Rate for Payer: Idaho Integrated Healthcare Commercial $145.50
Rate for Payer: Multiplan Medicare/VA $94.05
Rate for Payer: One Health Plan of WY PPO $147.00
Rate for Payer: PacificSource Commercial $135.00
Rate for Payer: PHCS PPO $147.00
Rate for Payer: Three Rivers PPO $112.50
Rate for Payer: TriWest Veterans Administration $99.00
Rate for Payer: United Healthcare Commercial $130.50
Rate for Payer: United Healthcare Medicare $99.00
Rate for Payer: WINHealth Partners Commercial $142.50
Rate for Payer: Wise Provider Network Commercial $142.50
Service Code HCPCS 97022
Hospital Charge Code 4309702201
Hospital Revenue Code 430
Min. Negotiated Rate $144.21
Max. Negotiated Rate $230.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $225.40
Rate for Payer: Altius Auto/Workers Compensation $220.80
Rate for Payer: Altius Commercial $220.80
Rate for Payer: Beech Street Commercial $225.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $188.83
Rate for Payer: Cash Price $161.00
Rate for Payer: ChoiceCare Network Commercial $223.10
Rate for Payer: Cigna of WY Commercial $225.40
Rate for Payer: Entrust Commercial $218.50
Rate for Payer: First Choice Health Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $151.80
Rate for Payer: HealthUtah PPO $230.00
Rate for Payer: Idaho Integrated Healthcare Commercial $223.10
Rate for Payer: Multiplan Medicare/VA $144.21
Rate for Payer: One Health Plan of WY PPO $225.40
Rate for Payer: PacificSource Commercial $207.00
Rate for Payer: PHCS PPO $225.40
Rate for Payer: Three Rivers PPO $172.50
Rate for Payer: TriWest Veterans Administration $151.80
Rate for Payer: United Healthcare Commercial $200.10
Rate for Payer: United Healthcare Medicare $151.80
Rate for Payer: WINHealth Partners Commercial $218.50
Rate for Payer: Wise Provider Network Commercial $218.50
Service Code HCPCS 97022
Hospital Charge Code 4309702201
Hospital Revenue Code 430
Min. Negotiated Rate $126.73
Max. Negotiated Rate $230.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $225.40
Rate for Payer: Aetna of WY Medicare $151.80
Rate for Payer: Altius Auto/Workers Compensation $220.80
Rate for Payer: Altius Commercial $220.80
Rate for Payer: Beech Street Commercial $225.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $188.83
Rate for Payer: Cash Price $161.00
Rate for Payer: ChoiceCare Network Commercial $223.10
Rate for Payer: Cigna of WY Commercial $225.40
Rate for Payer: Entrust Commercial $218.50
Rate for Payer: First Choice Health Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $133.40
Rate for Payer: HealthUtah PPO $230.00
Rate for Payer: Idaho Integrated Healthcare Commercial $223.10
Rate for Payer: Multiplan Medicare/VA $126.73
Rate for Payer: One Health Plan of WY PPO $225.40
Rate for Payer: PacificSource Commercial $207.00
Rate for Payer: PHCS PPO $225.40
Rate for Payer: Three Rivers PPO $172.50
Rate for Payer: TriWest Veterans Administration $133.40
Rate for Payer: United Healthcare Commercial $200.10
Rate for Payer: United Healthcare Medicare $133.40
Rate for Payer: WINHealth Partners Commercial $225.40
Rate for Payer: Wise Provider Network Commercial $218.50
Service Code HCPCS 97545
Hospital Charge Code 4309754501
Hospital Revenue Code 430
Min. Negotiated Rate $144.21
Max. Negotiated Rate $230.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $225.40
Rate for Payer: Altius Auto/Workers Compensation $220.80
Rate for Payer: Altius Commercial $220.80
Rate for Payer: Beech Street Commercial $225.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $188.83
Rate for Payer: Cash Price $161.00
Rate for Payer: ChoiceCare Network Commercial $223.10
Rate for Payer: Cigna of WY Commercial $225.40
Rate for Payer: Entrust Commercial $218.50
Rate for Payer: First Choice Health Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $218.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $151.80
Rate for Payer: HealthUtah PPO $230.00
Rate for Payer: Idaho Integrated Healthcare Commercial $223.10
Rate for Payer: Multiplan Medicare/VA $144.21
Rate for Payer: One Health Plan of WY PPO $225.40
Rate for Payer: PacificSource Commercial $207.00
Rate for Payer: PHCS PPO $225.40
Rate for Payer: Three Rivers PPO $172.50
Rate for Payer: TriWest Veterans Administration $151.80
Rate for Payer: United Healthcare Commercial $200.10
Rate for Payer: United Healthcare Medicare $151.80
Rate for Payer: WINHealth Partners Commercial $218.50
Rate for Payer: Wise Provider Network Commercial $218.50