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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
Service Code HCPCS 97602
Hospital Charge Code 4309760201
Hospital Revenue Code 430
Min. Negotiated Rate $214.89
Max. Negotiated Rate $390.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $382.20
Rate for Payer: Aetna of WY Medicare $257.40
Rate for Payer: Altius Auto/Workers Compensation $374.40
Rate for Payer: Altius Commercial $374.40
Rate for Payer: Beech Street Commercial $382.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $320.19
Rate for Payer: Cash Price $273.00
Rate for Payer: ChoiceCare Network Commercial $378.30
Rate for Payer: Cigna of WY Commercial $382.20
Rate for Payer: Entrust Commercial $370.50
Rate for Payer: First Choice Health Commercial $370.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $370.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $226.20
Rate for Payer: HealthUtah PPO $390.00
Rate for Payer: Idaho Integrated Healthcare Commercial $378.30
Rate for Payer: Multiplan Medicare/VA $214.89
Rate for Payer: One Health Plan of WY PPO $382.20
Rate for Payer: PacificSource Commercial $351.00
Rate for Payer: PHCS PPO $382.20
Rate for Payer: Three Rivers PPO $292.50
Rate for Payer: TriWest Veterans Administration $226.20
Rate for Payer: United Healthcare Commercial $339.30
Rate for Payer: United Healthcare Medicare $226.20
Rate for Payer: WINHealth Partners Commercial $382.20
Rate for Payer: Wise Provider Network Commercial $370.50
Service Code HCPCS 97602
Hospital Charge Code 4309760201
Hospital Revenue Code 430
Min. Negotiated Rate $244.53
Max. Negotiated Rate $390.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $382.20
Rate for Payer: Altius Auto/Workers Compensation $374.40
Rate for Payer: Altius Commercial $374.40
Rate for Payer: Beech Street Commercial $382.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $320.19
Rate for Payer: Cash Price $273.00
Rate for Payer: ChoiceCare Network Commercial $378.30
Rate for Payer: Cigna of WY Commercial $382.20
Rate for Payer: Entrust Commercial $370.50
Rate for Payer: First Choice Health Commercial $370.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $370.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $257.40
Rate for Payer: HealthUtah PPO $390.00
Rate for Payer: Idaho Integrated Healthcare Commercial $378.30
Rate for Payer: Multiplan Medicare/VA $244.53
Rate for Payer: One Health Plan of WY PPO $382.20
Rate for Payer: PacificSource Commercial $351.00
Rate for Payer: PHCS PPO $382.20
Rate for Payer: Three Rivers PPO $292.50
Rate for Payer: TriWest Veterans Administration $257.40
Rate for Payer: United Healthcare Commercial $339.30
Rate for Payer: United Healthcare Medicare $257.40
Rate for Payer: WINHealth Partners Commercial $370.50
Rate for Payer: Wise Provider Network Commercial $370.50
Service Code HCPCS 93798
Hospital Charge Code 9439379801
Hospital Revenue Code 943
Min. Negotiated Rate $247.95
Max. Negotiated Rate $450.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $441.00
Rate for Payer: Aetna of WY Medicare $297.00
Rate for Payer: Altius Auto/Workers Compensation $432.00
Rate for Payer: Altius Commercial $432.00
Rate for Payer: Beech Street Commercial $441.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $369.45
Rate for Payer: Cash Price $315.00
Rate for Payer: ChoiceCare Network Commercial $436.50
Rate for Payer: Cigna of WY Commercial $441.00
Rate for Payer: Entrust Commercial $427.50
Rate for Payer: First Choice Health Commercial $427.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $427.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $261.00
Rate for Payer: HealthUtah PPO $450.00
Rate for Payer: Idaho Integrated Healthcare Commercial $436.50
Rate for Payer: Multiplan Medicare/VA $247.95
Rate for Payer: One Health Plan of WY PPO $441.00
Rate for Payer: PacificSource Commercial $405.00
Rate for Payer: PHCS PPO $441.00
Rate for Payer: Three Rivers PPO $337.50
Rate for Payer: TriWest Veterans Administration $261.00
Rate for Payer: United Healthcare Commercial $391.50
Rate for Payer: United Healthcare Medicare $261.00
Rate for Payer: WINHealth Partners Commercial $441.00
Rate for Payer: Wise Provider Network Commercial $427.50
Service Code HCPCS 93798
Hospital Charge Code 9439379801
Hospital Revenue Code 943
Min. Negotiated Rate $282.15
Max. Negotiated Rate $450.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $441.00
Rate for Payer: Altius Auto/Workers Compensation $432.00
Rate for Payer: Altius Commercial $432.00
Rate for Payer: Beech Street Commercial $441.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $369.45
Rate for Payer: Cash Price $315.00
Rate for Payer: ChoiceCare Network Commercial $436.50
Rate for Payer: Cigna of WY Commercial $441.00
Rate for Payer: Entrust Commercial $427.50
Rate for Payer: First Choice Health Commercial $427.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $427.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $297.00
Rate for Payer: HealthUtah PPO $450.00
Rate for Payer: Idaho Integrated Healthcare Commercial $436.50
Rate for Payer: Multiplan Medicare/VA $282.15
Rate for Payer: One Health Plan of WY PPO $441.00
Rate for Payer: PacificSource Commercial $405.00
Rate for Payer: PHCS PPO $441.00
Rate for Payer: Three Rivers PPO $337.50
Rate for Payer: TriWest Veterans Administration $297.00
Rate for Payer: United Healthcare Commercial $391.50
Rate for Payer: United Healthcare Medicare $297.00
Rate for Payer: WINHealth Partners Commercial $427.50
Rate for Payer: Wise Provider Network Commercial $427.50
Service Code HCPCS 81503
Hospital Charge Code 3108150301
Hospital Revenue Code 310
Min. Negotiated Rate $4,399.74
Max. Negotiated Rate $7,985.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $7,825.30
Rate for Payer: Aetna of WY Medicare $5,270.10
Rate for Payer: Altius Auto/Workers Compensation $7,665.60
Rate for Payer: Altius Commercial $7,665.60
Rate for Payer: Beech Street Commercial $7,825.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6,555.68
Rate for Payer: Cash Price $5,589.50
Rate for Payer: ChoiceCare Network Commercial $7,745.45
Rate for Payer: Cigna of WY Commercial $7,825.30
Rate for Payer: Entrust Commercial $7,585.75
Rate for Payer: First Choice Health Commercial $7,585.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7,585.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4,631.30
Rate for Payer: HealthUtah PPO $7,985.00
Rate for Payer: Idaho Integrated Healthcare Commercial $7,745.45
Rate for Payer: Multiplan Medicare/VA $4,399.74
Rate for Payer: One Health Plan of WY PPO $7,825.30
Rate for Payer: PacificSource Commercial $7,186.50
Rate for Payer: PHCS PPO $7,825.30
Rate for Payer: Three Rivers PPO $5,988.75
Rate for Payer: TriWest Veterans Administration $4,631.30
Rate for Payer: United Healthcare Commercial $6,946.95
Rate for Payer: United Healthcare Medicare $4,631.30
Rate for Payer: WINHealth Partners Commercial $7,825.30
Rate for Payer: Wise Provider Network Commercial $7,585.75
Service Code HCPCS 81503
Hospital Charge Code 3108150301
Hospital Revenue Code 310
Min. Negotiated Rate $5,006.60
Max. Negotiated Rate $7,985.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $7,825.30
Rate for Payer: Altius Auto/Workers Compensation $7,665.60
Rate for Payer: Altius Commercial $7,665.60
Rate for Payer: Beech Street Commercial $7,825.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6,555.68
Rate for Payer: Cash Price $5,589.50
Rate for Payer: ChoiceCare Network Commercial $7,745.45
Rate for Payer: Cigna of WY Commercial $7,825.30
Rate for Payer: Entrust Commercial $7,585.75
Rate for Payer: First Choice Health Commercial $7,585.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7,585.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5,270.10
Rate for Payer: HealthUtah PPO $7,985.00
Rate for Payer: Idaho Integrated Healthcare Commercial $7,745.45
Rate for Payer: Multiplan Medicare/VA $5,006.60
Rate for Payer: One Health Plan of WY PPO $7,825.30
Rate for Payer: PacificSource Commercial $7,186.50
Rate for Payer: PHCS PPO $7,825.30
Rate for Payer: Three Rivers PPO $5,988.75
Rate for Payer: TriWest Veterans Administration $5,270.10
Rate for Payer: United Healthcare Commercial $6,946.95
Rate for Payer: United Healthcare Medicare $5,270.10
Rate for Payer: WINHealth Partners Commercial $7,585.75
Rate for Payer: Wise Provider Network Commercial $7,585.75
Service Code HCPCS 87177
Hospital Charge Code 3068717701
Hospital Revenue Code 306
Min. Negotiated Rate $90.92
Max. Negotiated Rate $165.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $161.70
Rate for Payer: Aetna of WY Medicare $108.90
Rate for Payer: Altius Auto/Workers Compensation $158.40
Rate for Payer: Altius Commercial $158.40
Rate for Payer: Beech Street Commercial $161.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $135.46
Rate for Payer: Cash Price $115.50
Rate for Payer: ChoiceCare Network Commercial $160.05
Rate for Payer: Cigna of WY Commercial $161.70
Rate for Payer: Entrust Commercial $156.75
Rate for Payer: First Choice Health Commercial $156.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $156.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $95.70
Rate for Payer: HealthUtah PPO $165.00
Rate for Payer: Idaho Integrated Healthcare Commercial $160.05
Rate for Payer: Multiplan Medicare/VA $90.92
Rate for Payer: One Health Plan of WY PPO $161.70
Rate for Payer: PacificSource Commercial $148.50
Rate for Payer: PHCS PPO $161.70
Rate for Payer: Three Rivers PPO $123.75
Rate for Payer: TriWest Veterans Administration $95.70
Rate for Payer: United Healthcare Commercial $143.55
Rate for Payer: United Healthcare Medicare $95.70
Rate for Payer: WINHealth Partners Commercial $161.70
Rate for Payer: Wise Provider Network Commercial $156.75
Service Code HCPCS 87177
Hospital Charge Code 3068717701
Hospital Revenue Code 306
Min. Negotiated Rate $103.46
Max. Negotiated Rate $165.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $161.70
Rate for Payer: Altius Auto/Workers Compensation $158.40
Rate for Payer: Altius Commercial $158.40
Rate for Payer: Beech Street Commercial $161.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $135.46
Rate for Payer: Cash Price $115.50
Rate for Payer: ChoiceCare Network Commercial $160.05
Rate for Payer: Cigna of WY Commercial $161.70
Rate for Payer: Entrust Commercial $156.75
Rate for Payer: First Choice Health Commercial $156.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $156.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $108.90
Rate for Payer: HealthUtah PPO $165.00
Rate for Payer: Idaho Integrated Healthcare Commercial $160.05
Rate for Payer: Multiplan Medicare/VA $103.46
Rate for Payer: One Health Plan of WY PPO $161.70
Rate for Payer: PacificSource Commercial $148.50
Rate for Payer: PHCS PPO $161.70
Rate for Payer: Three Rivers PPO $123.75
Rate for Payer: TriWest Veterans Administration $108.90
Rate for Payer: United Healthcare Commercial $143.55
Rate for Payer: United Healthcare Medicare $108.90
Rate for Payer: WINHealth Partners Commercial $156.75
Rate for Payer: Wise Provider Network Commercial $156.75
Service Code HCPCS 87279
Hospital Charge Code 3008727901
Hospital Revenue Code 300
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 87279
Hospital Charge Code 3008727901
Hospital Revenue Code 300
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 78070
Hospital Charge Code 3417807001
Hospital Revenue Code 341
Min. Negotiated Rate $1,046.90
Max. Negotiated Rate $1,900.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,862.00
Rate for Payer: Aetna of WY Medicare $1,254.00
Rate for Payer: Altius Auto/Workers Compensation $1,824.00
Rate for Payer: Altius Commercial $1,824.00
Rate for Payer: Beech Street Commercial $1,862.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,559.90
Rate for Payer: Cash Price $1,330.00
Rate for Payer: ChoiceCare Network Commercial $1,843.00
Rate for Payer: Cigna of WY Commercial $1,862.00
Rate for Payer: Entrust Commercial $1,805.00
Rate for Payer: First Choice Health Commercial $1,805.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,805.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,102.00
Rate for Payer: HealthUtah PPO $1,900.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,843.00
Rate for Payer: Multiplan Medicare/VA $1,046.90
Rate for Payer: One Health Plan of WY PPO $1,862.00
Rate for Payer: PacificSource Commercial $1,710.00
Rate for Payer: PHCS PPO $1,862.00
Rate for Payer: Three Rivers PPO $1,425.00
Rate for Payer: TriWest Veterans Administration $1,102.00
Rate for Payer: United Healthcare Commercial $1,653.00
Rate for Payer: United Healthcare Medicare $1,102.00
Rate for Payer: WINHealth Partners Commercial $1,862.00
Rate for Payer: Wise Provider Network Commercial $1,805.00
Service Code HCPCS 78070
Hospital Charge Code 3417807001
Hospital Revenue Code 341
Min. Negotiated Rate $1,191.30
Max. Negotiated Rate $1,900.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,862.00
Rate for Payer: Altius Auto/Workers Compensation $1,824.00
Rate for Payer: Altius Commercial $1,824.00
Rate for Payer: Beech Street Commercial $1,862.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,559.90
Rate for Payer: Cash Price $1,330.00
Rate for Payer: ChoiceCare Network Commercial $1,843.00
Rate for Payer: Cigna of WY Commercial $1,862.00
Rate for Payer: Entrust Commercial $1,805.00
Rate for Payer: First Choice Health Commercial $1,805.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,805.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,254.00
Rate for Payer: HealthUtah PPO $1,900.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,843.00
Rate for Payer: Multiplan Medicare/VA $1,191.30
Rate for Payer: One Health Plan of WY PPO $1,862.00
Rate for Payer: PacificSource Commercial $1,710.00
Rate for Payer: PHCS PPO $1,862.00
Rate for Payer: Three Rivers PPO $1,425.00
Rate for Payer: TriWest Veterans Administration $1,254.00
Rate for Payer: United Healthcare Commercial $1,653.00
Rate for Payer: United Healthcare Medicare $1,254.00
Rate for Payer: WINHealth Partners Commercial $1,805.00
Rate for Payer: Wise Provider Network Commercial $1,805.00
Service Code HCPCS 86403
Hospital Charge Code 3028640303
Hospital Revenue Code 302
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640303
Hospital Revenue Code 302
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640305
Hospital Revenue Code 302
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640305
Hospital Revenue Code 302
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640307
Hospital Revenue Code 302
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640307
Hospital Revenue Code 302
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640309
Hospital Revenue Code 302
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640309
Hospital Revenue Code 302
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640308
Hospital Revenue Code 302
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640308
Hospital Revenue Code 302
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640304
Hospital Revenue Code 302
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86403
Hospital Charge Code 3028640304
Hospital Revenue Code 302
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00