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Service Code HCPCS 99212
Hospital Charge Code 5109921201
Hospital Revenue Code 510
Min. Negotiated Rate $16.30
Max. Negotiated Rate $26.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.48
Rate for Payer: Altius Auto/Workers Compensation $24.96
Rate for Payer: Altius Commercial $24.96
Rate for Payer: Beech Street Commercial $25.48
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.35
Rate for Payer: Cash Price $18.20
Rate for Payer: ChoiceCare Network Commercial $25.22
Rate for Payer: Cigna of WY Commercial $25.48
Rate for Payer: Entrust Commercial $24.70
Rate for Payer: First Choice Health Commercial $24.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.16
Rate for Payer: HealthUtah PPO $26.00
Rate for Payer: Idaho Integrated Healthcare Commercial $25.22
Rate for Payer: Multiplan Medicare/VA $16.30
Rate for Payer: One Health Plan of WY PPO $25.48
Rate for Payer: PacificSource Commercial $23.40
Rate for Payer: PHCS PPO $25.48
Rate for Payer: Three Rivers PPO $19.50
Rate for Payer: TriWest Veterans Administration $17.16
Rate for Payer: United Healthcare Commercial $22.62
Rate for Payer: United Healthcare Medicare $17.16
Rate for Payer: WINHealth Partners Commercial $24.70
Rate for Payer: Wise Provider Network Commercial $24.70
Service Code HCPCS 99213
Hospital Charge Code 5109921301
Hospital Revenue Code 510
Min. Negotiated Rate $18.18
Max. Negotiated Rate $63.48
Rate for Payer: Aetna of WY Commercial/Medical Rental $32.34
Rate for Payer: Aetna of WY Medicare $21.78
Rate for Payer: Altius Auto/Workers Compensation $31.68
Rate for Payer: Altius Commercial $31.68
Rate for Payer: Beech Street Commercial $32.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $27.09
Rate for Payer: Cash Price $23.10
Rate for Payer: Cash Price $23.10
Rate for Payer: ChoiceCare Network Commercial $32.01
Rate for Payer: Cigna of WY Commercial $32.34
Rate for Payer: Entrust Commercial $31.35
Rate for Payer: First Choice Health Commercial $31.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $31.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $19.14
Rate for Payer: HealthUtah PPO $63.48
Rate for Payer: Idaho Integrated Healthcare Commercial $32.01
Rate for Payer: Multiplan Medicare/VA $18.18
Rate for Payer: One Health Plan of WY PPO $32.34
Rate for Payer: PacificSource Commercial $29.70
Rate for Payer: PHCS PPO $32.34
Rate for Payer: Three Rivers PPO $24.75
Rate for Payer: TriWest Veterans Administration $19.14
Rate for Payer: United Healthcare Commercial $28.71
Rate for Payer: United Healthcare Medicare $19.14
Rate for Payer: WINHealth Partners Commercial $32.34
Rate for Payer: Wise Provider Network Commercial $31.35
Service Code HCPCS 99213
Hospital Charge Code 5109921301
Hospital Revenue Code 510
Min. Negotiated Rate $20.69
Max. Negotiated Rate $33.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $32.34
Rate for Payer: Altius Auto/Workers Compensation $31.68
Rate for Payer: Altius Commercial $31.68
Rate for Payer: Beech Street Commercial $32.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $27.09
Rate for Payer: Cash Price $23.10
Rate for Payer: ChoiceCare Network Commercial $32.01
Rate for Payer: Cigna of WY Commercial $32.34
Rate for Payer: Entrust Commercial $31.35
Rate for Payer: First Choice Health Commercial $31.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $31.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $21.78
Rate for Payer: HealthUtah PPO $33.00
Rate for Payer: Idaho Integrated Healthcare Commercial $32.01
Rate for Payer: Multiplan Medicare/VA $20.69
Rate for Payer: One Health Plan of WY PPO $32.34
Rate for Payer: PacificSource Commercial $29.70
Rate for Payer: PHCS PPO $32.34
Rate for Payer: Three Rivers PPO $24.75
Rate for Payer: TriWest Veterans Administration $21.78
Rate for Payer: United Healthcare Commercial $28.71
Rate for Payer: United Healthcare Medicare $21.78
Rate for Payer: WINHealth Partners Commercial $31.35
Rate for Payer: Wise Provider Network Commercial $31.35
Service Code HCPCS 99214
Hospital Charge Code 5109921401
Hospital Revenue Code 510
Min. Negotiated Rate $30.10
Max. Negotiated Rate $48.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $47.04
Rate for Payer: Altius Auto/Workers Compensation $46.08
Rate for Payer: Altius Commercial $46.08
Rate for Payer: Beech Street Commercial $47.04
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $39.41
Rate for Payer: Cash Price $33.60
Rate for Payer: ChoiceCare Network Commercial $46.56
Rate for Payer: Cigna of WY Commercial $47.04
Rate for Payer: Entrust Commercial $45.60
Rate for Payer: First Choice Health Commercial $45.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $45.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $31.68
Rate for Payer: HealthUtah PPO $48.00
Rate for Payer: Idaho Integrated Healthcare Commercial $46.56
Rate for Payer: Multiplan Medicare/VA $30.10
Rate for Payer: One Health Plan of WY PPO $47.04
Rate for Payer: PacificSource Commercial $43.20
Rate for Payer: PHCS PPO $47.04
Rate for Payer: Three Rivers PPO $36.00
Rate for Payer: TriWest Veterans Administration $31.68
Rate for Payer: United Healthcare Commercial $41.76
Rate for Payer: United Healthcare Medicare $31.68
Rate for Payer: WINHealth Partners Commercial $45.60
Rate for Payer: Wise Provider Network Commercial $45.60
Service Code HCPCS 99214
Hospital Charge Code 5109921401
Hospital Revenue Code 510
Min. Negotiated Rate $26.45
Max. Negotiated Rate $99.74
Rate for Payer: Aetna of WY Commercial/Medical Rental $47.04
Rate for Payer: Aetna of WY Medicare $31.68
Rate for Payer: Altius Auto/Workers Compensation $46.08
Rate for Payer: Altius Commercial $46.08
Rate for Payer: Beech Street Commercial $47.04
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $39.41
Rate for Payer: Cash Price $33.60
Rate for Payer: Cash Price $33.60
Rate for Payer: ChoiceCare Network Commercial $46.56
Rate for Payer: Cigna of WY Commercial $47.04
Rate for Payer: Entrust Commercial $45.60
Rate for Payer: First Choice Health Commercial $45.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $45.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $27.84
Rate for Payer: HealthUtah PPO $99.74
Rate for Payer: Idaho Integrated Healthcare Commercial $46.56
Rate for Payer: Multiplan Medicare/VA $26.45
Rate for Payer: One Health Plan of WY PPO $47.04
Rate for Payer: PacificSource Commercial $43.20
Rate for Payer: PHCS PPO $47.04
Rate for Payer: Three Rivers PPO $36.00
Rate for Payer: TriWest Veterans Administration $27.84
Rate for Payer: United Healthcare Commercial $41.76
Rate for Payer: United Healthcare Medicare $27.84
Rate for Payer: WINHealth Partners Commercial $47.04
Rate for Payer: Wise Provider Network Commercial $45.60
Service Code HCPCS 99215
Hospital Charge Code 5109921501
Hospital Revenue Code 510
Min. Negotiated Rate $44.63
Max. Negotiated Rate $146.51
Rate for Payer: Aetna of WY Commercial/Medical Rental $79.38
Rate for Payer: Aetna of WY Medicare $53.46
Rate for Payer: Altius Auto/Workers Compensation $77.76
Rate for Payer: Altius Commercial $77.76
Rate for Payer: Beech Street Commercial $79.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $66.50
Rate for Payer: Cash Price $56.70
Rate for Payer: Cash Price $56.70
Rate for Payer: ChoiceCare Network Commercial $78.57
Rate for Payer: Cigna of WY Commercial $79.38
Rate for Payer: Entrust Commercial $76.95
Rate for Payer: First Choice Health Commercial $76.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $76.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $46.98
Rate for Payer: HealthUtah PPO $146.51
Rate for Payer: Idaho Integrated Healthcare Commercial $78.57
Rate for Payer: Multiplan Medicare/VA $44.63
Rate for Payer: One Health Plan of WY PPO $79.38
Rate for Payer: PacificSource Commercial $72.90
Rate for Payer: PHCS PPO $79.38
Rate for Payer: Three Rivers PPO $60.75
Rate for Payer: TriWest Veterans Administration $46.98
Rate for Payer: United Healthcare Commercial $70.47
Rate for Payer: United Healthcare Medicare $46.98
Rate for Payer: WINHealth Partners Commercial $79.38
Rate for Payer: Wise Provider Network Commercial $76.95
Service Code HCPCS 99215
Hospital Charge Code 5109921501
Hospital Revenue Code 510
Min. Negotiated Rate $50.79
Max. Negotiated Rate $81.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $79.38
Rate for Payer: Altius Auto/Workers Compensation $77.76
Rate for Payer: Altius Commercial $77.76
Rate for Payer: Beech Street Commercial $79.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $66.50
Rate for Payer: Cash Price $56.70
Rate for Payer: ChoiceCare Network Commercial $78.57
Rate for Payer: Cigna of WY Commercial $79.38
Rate for Payer: Entrust Commercial $76.95
Rate for Payer: First Choice Health Commercial $76.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $76.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $53.46
Rate for Payer: HealthUtah PPO $81.00
Rate for Payer: Idaho Integrated Healthcare Commercial $78.57
Rate for Payer: Multiplan Medicare/VA $50.79
Rate for Payer: One Health Plan of WY PPO $79.38
Rate for Payer: PacificSource Commercial $72.90
Rate for Payer: PHCS PPO $79.38
Rate for Payer: Three Rivers PPO $60.75
Rate for Payer: TriWest Veterans Administration $53.46
Rate for Payer: United Healthcare Commercial $70.47
Rate for Payer: United Healthcare Medicare $53.46
Rate for Payer: WINHealth Partners Commercial $76.95
Rate for Payer: Wise Provider Network Commercial $76.95
Service Code HCPCS 99496
Hospital Charge Code 5109949601
Hospital Revenue Code 510
Min. Negotiated Rate $88.71
Max. Negotiated Rate $161.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $157.78
Rate for Payer: Aetna of WY Medicare $106.26
Rate for Payer: Altius Auto/Workers Compensation $154.56
Rate for Payer: Altius Commercial $154.56
Rate for Payer: Beech Street Commercial $157.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $132.18
Rate for Payer: Cash Price $112.70
Rate for Payer: ChoiceCare Network Commercial $156.17
Rate for Payer: Cigna of WY Commercial $157.78
Rate for Payer: Entrust Commercial $152.95
Rate for Payer: First Choice Health Commercial $152.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $93.38
Rate for Payer: HealthUtah PPO $161.00
Rate for Payer: Idaho Integrated Healthcare Commercial $156.17
Rate for Payer: Multiplan Medicare/VA $88.71
Rate for Payer: One Health Plan of WY PPO $157.78
Rate for Payer: PacificSource Commercial $144.90
Rate for Payer: PHCS PPO $157.78
Rate for Payer: Three Rivers PPO $120.75
Rate for Payer: TriWest Veterans Administration $93.38
Rate for Payer: United Healthcare Commercial $140.07
Rate for Payer: United Healthcare Medicare $93.38
Rate for Payer: WINHealth Partners Commercial $157.78
Rate for Payer: Wise Provider Network Commercial $152.95
Service Code HCPCS 99496
Hospital Charge Code 5109949601
Hospital Revenue Code 510
Min. Negotiated Rate $100.95
Max. Negotiated Rate $161.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $157.78
Rate for Payer: Altius Auto/Workers Compensation $154.56
Rate for Payer: Altius Commercial $154.56
Rate for Payer: Beech Street Commercial $157.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $132.18
Rate for Payer: Cash Price $112.70
Rate for Payer: ChoiceCare Network Commercial $156.17
Rate for Payer: Cigna of WY Commercial $157.78
Rate for Payer: Entrust Commercial $152.95
Rate for Payer: First Choice Health Commercial $152.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $106.26
Rate for Payer: HealthUtah PPO $161.00
Rate for Payer: Idaho Integrated Healthcare Commercial $156.17
Rate for Payer: Multiplan Medicare/VA $100.95
Rate for Payer: One Health Plan of WY PPO $157.78
Rate for Payer: PacificSource Commercial $144.90
Rate for Payer: PHCS PPO $157.78
Rate for Payer: Three Rivers PPO $120.75
Rate for Payer: TriWest Veterans Administration $106.26
Rate for Payer: United Healthcare Commercial $140.07
Rate for Payer: United Healthcare Medicare $106.26
Rate for Payer: WINHealth Partners Commercial $152.95
Rate for Payer: Wise Provider Network Commercial $152.95
Service Code HCPCS 57410
Hospital Charge Code 5105741001
Hospital Revenue Code 510
Min. Negotiated Rate $67.09
Max. Negotiated Rate $107.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $104.86
Rate for Payer: Altius Auto/Workers Compensation $102.72
Rate for Payer: Altius Commercial $102.72
Rate for Payer: Beech Street Commercial $104.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $87.85
Rate for Payer: Cash Price $74.90
Rate for Payer: ChoiceCare Network Commercial $103.79
Rate for Payer: Cigna of WY Commercial $104.86
Rate for Payer: Entrust Commercial $101.65
Rate for Payer: First Choice Health Commercial $101.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $101.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $70.62
Rate for Payer: HealthUtah PPO $107.00
Rate for Payer: Idaho Integrated Healthcare Commercial $103.79
Rate for Payer: Multiplan Medicare/VA $67.09
Rate for Payer: One Health Plan of WY PPO $104.86
Rate for Payer: PacificSource Commercial $96.30
Rate for Payer: PHCS PPO $104.86
Rate for Payer: Three Rivers PPO $80.25
Rate for Payer: TriWest Veterans Administration $70.62
Rate for Payer: United Healthcare Commercial $93.09
Rate for Payer: United Healthcare Medicare $70.62
Rate for Payer: WINHealth Partners Commercial $101.65
Rate for Payer: Wise Provider Network Commercial $101.65
Service Code HCPCS 57410
Hospital Charge Code 5105741001
Hospital Revenue Code 510
Min. Negotiated Rate $58.96
Max. Negotiated Rate $107.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $104.86
Rate for Payer: Aetna of WY Medicare $70.62
Rate for Payer: Altius Auto/Workers Compensation $102.72
Rate for Payer: Altius Commercial $102.72
Rate for Payer: Beech Street Commercial $104.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $87.85
Rate for Payer: Cash Price $74.90
Rate for Payer: ChoiceCare Network Commercial $103.79
Rate for Payer: Cigna of WY Commercial $104.86
Rate for Payer: Entrust Commercial $101.65
Rate for Payer: First Choice Health Commercial $101.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $101.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $62.06
Rate for Payer: HealthUtah PPO $107.00
Rate for Payer: Idaho Integrated Healthcare Commercial $103.79
Rate for Payer: Multiplan Medicare/VA $58.96
Rate for Payer: One Health Plan of WY PPO $104.86
Rate for Payer: PacificSource Commercial $96.30
Rate for Payer: PHCS PPO $104.86
Rate for Payer: Three Rivers PPO $80.25
Rate for Payer: TriWest Veterans Administration $62.06
Rate for Payer: United Healthcare Commercial $93.09
Rate for Payer: United Healthcare Medicare $62.06
Rate for Payer: WINHealth Partners Commercial $104.86
Rate for Payer: Wise Provider Network Commercial $101.65
Service Code HCPCS 94642
Hospital Charge Code 4109464201
Hospital Revenue Code 410
Min. Negotiated Rate $253.94
Max. Negotiated Rate $405.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $396.90
Rate for Payer: Altius Auto/Workers Compensation $388.80
Rate for Payer: Altius Commercial $388.80
Rate for Payer: Beech Street Commercial $396.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $332.50
Rate for Payer: Cash Price $283.50
Rate for Payer: ChoiceCare Network Commercial $392.85
Rate for Payer: Cigna of WY Commercial $396.90
Rate for Payer: Entrust Commercial $384.75
Rate for Payer: First Choice Health Commercial $384.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $384.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $267.30
Rate for Payer: HealthUtah PPO $405.00
Rate for Payer: Idaho Integrated Healthcare Commercial $392.85
Rate for Payer: Multiplan Medicare/VA $253.94
Rate for Payer: One Health Plan of WY PPO $396.90
Rate for Payer: PacificSource Commercial $364.50
Rate for Payer: PHCS PPO $396.90
Rate for Payer: Three Rivers PPO $303.75
Rate for Payer: TriWest Veterans Administration $267.30
Rate for Payer: United Healthcare Commercial $352.35
Rate for Payer: United Healthcare Medicare $267.30
Rate for Payer: WINHealth Partners Commercial $384.75
Rate for Payer: Wise Provider Network Commercial $384.75
Service Code HCPCS 94642
Hospital Charge Code 4109464201
Hospital Revenue Code 410
Min. Negotiated Rate $223.16
Max. Negotiated Rate $405.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $396.90
Rate for Payer: Aetna of WY Medicare $267.30
Rate for Payer: Altius Auto/Workers Compensation $388.80
Rate for Payer: Altius Commercial $388.80
Rate for Payer: Beech Street Commercial $396.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $332.50
Rate for Payer: Cash Price $283.50
Rate for Payer: ChoiceCare Network Commercial $392.85
Rate for Payer: Cigna of WY Commercial $396.90
Rate for Payer: Entrust Commercial $384.75
Rate for Payer: First Choice Health Commercial $384.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $384.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $234.90
Rate for Payer: HealthUtah PPO $405.00
Rate for Payer: Idaho Integrated Healthcare Commercial $392.85
Rate for Payer: Multiplan Medicare/VA $223.16
Rate for Payer: One Health Plan of WY PPO $396.90
Rate for Payer: PacificSource Commercial $364.50
Rate for Payer: PHCS PPO $396.90
Rate for Payer: Three Rivers PPO $303.75
Rate for Payer: TriWest Veterans Administration $234.90
Rate for Payer: United Healthcare Commercial $352.35
Rate for Payer: United Healthcare Medicare $234.90
Rate for Payer: WINHealth Partners Commercial $396.90
Rate for Payer: Wise Provider Network Commercial $384.75
Service Code HCPCS 49180
Hospital Charge Code 3504918001
Hospital Revenue Code 350
Min. Negotiated Rate $3,774.35
Max. Negotiated Rate $6,850.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $6,713.00
Rate for Payer: Aetna of WY Medicare $4,521.00
Rate for Payer: Altius Auto/Workers Compensation $6,576.00
Rate for Payer: Altius Commercial $6,576.00
Rate for Payer: Beech Street Commercial $6,713.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5,623.85
Rate for Payer: Cash Price $4,795.00
Rate for Payer: ChoiceCare Network Commercial $6,644.50
Rate for Payer: Cigna of WY Commercial $6,713.00
Rate for Payer: Entrust Commercial $6,507.50
Rate for Payer: First Choice Health Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,973.00
Rate for Payer: HealthUtah PPO $6,850.00
Rate for Payer: Idaho Integrated Healthcare Commercial $6,644.50
Rate for Payer: Multiplan Medicare/VA $3,774.35
Rate for Payer: One Health Plan of WY PPO $6,713.00
Rate for Payer: PacificSource Commercial $6,165.00
Rate for Payer: PHCS PPO $6,713.00
Rate for Payer: Three Rivers PPO $5,137.50
Rate for Payer: TriWest Veterans Administration $3,973.00
Rate for Payer: United Healthcare Commercial $5,959.50
Rate for Payer: United Healthcare Medicare $3,973.00
Rate for Payer: WINHealth Partners Commercial $6,713.00
Rate for Payer: Wise Provider Network Commercial $6,507.50
Service Code HCPCS 49180
Hospital Charge Code 3504918001
Hospital Revenue Code 350
Min. Negotiated Rate $4,294.95
Max. Negotiated Rate $6,850.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $6,713.00
Rate for Payer: Altius Auto/Workers Compensation $6,576.00
Rate for Payer: Altius Commercial $6,576.00
Rate for Payer: Beech Street Commercial $6,713.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5,623.85
Rate for Payer: Cash Price $4,795.00
Rate for Payer: ChoiceCare Network Commercial $6,644.50
Rate for Payer: Cigna of WY Commercial $6,713.00
Rate for Payer: Entrust Commercial $6,507.50
Rate for Payer: First Choice Health Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4,521.00
Rate for Payer: HealthUtah PPO $6,850.00
Rate for Payer: Idaho Integrated Healthcare Commercial $6,644.50
Rate for Payer: Multiplan Medicare/VA $4,294.95
Rate for Payer: One Health Plan of WY PPO $6,713.00
Rate for Payer: PacificSource Commercial $6,165.00
Rate for Payer: PHCS PPO $6,713.00
Rate for Payer: Three Rivers PPO $5,137.50
Rate for Payer: TriWest Veterans Administration $4,521.00
Rate for Payer: United Healthcare Commercial $5,959.50
Rate for Payer: United Healthcare Medicare $4,521.00
Rate for Payer: WINHealth Partners Commercial $6,507.50
Rate for Payer: Wise Provider Network Commercial $6,507.50
Service Code HCPCS 49180
Hospital Charge Code 3204918001
Hospital Revenue Code 320
Min. Negotiated Rate $3,774.35
Max. Negotiated Rate $6,850.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $6,713.00
Rate for Payer: Aetna of WY Medicare $4,521.00
Rate for Payer: Altius Auto/Workers Compensation $6,576.00
Rate for Payer: Altius Commercial $6,576.00
Rate for Payer: Beech Street Commercial $6,713.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5,623.85
Rate for Payer: Cash Price $4,795.00
Rate for Payer: ChoiceCare Network Commercial $6,644.50
Rate for Payer: Cigna of WY Commercial $6,713.00
Rate for Payer: Entrust Commercial $6,507.50
Rate for Payer: First Choice Health Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,973.00
Rate for Payer: HealthUtah PPO $6,850.00
Rate for Payer: Idaho Integrated Healthcare Commercial $6,644.50
Rate for Payer: Multiplan Medicare/VA $3,774.35
Rate for Payer: One Health Plan of WY PPO $6,713.00
Rate for Payer: PacificSource Commercial $6,165.00
Rate for Payer: PHCS PPO $6,713.00
Rate for Payer: Three Rivers PPO $5,137.50
Rate for Payer: TriWest Veterans Administration $3,973.00
Rate for Payer: United Healthcare Commercial $5,959.50
Rate for Payer: United Healthcare Medicare $3,973.00
Rate for Payer: WINHealth Partners Commercial $6,713.00
Rate for Payer: Wise Provider Network Commercial $6,507.50
Service Code HCPCS 49180
Hospital Charge Code 3204918001
Hospital Revenue Code 320
Min. Negotiated Rate $4,294.95
Max. Negotiated Rate $6,850.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $6,713.00
Rate for Payer: Altius Auto/Workers Compensation $6,576.00
Rate for Payer: Altius Commercial $6,576.00
Rate for Payer: Beech Street Commercial $6,713.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5,623.85
Rate for Payer: Cash Price $4,795.00
Rate for Payer: ChoiceCare Network Commercial $6,644.50
Rate for Payer: Cigna of WY Commercial $6,713.00
Rate for Payer: Entrust Commercial $6,507.50
Rate for Payer: First Choice Health Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4,521.00
Rate for Payer: HealthUtah PPO $6,850.00
Rate for Payer: Idaho Integrated Healthcare Commercial $6,644.50
Rate for Payer: Multiplan Medicare/VA $4,294.95
Rate for Payer: One Health Plan of WY PPO $6,713.00
Rate for Payer: PacificSource Commercial $6,165.00
Rate for Payer: PHCS PPO $6,713.00
Rate for Payer: Three Rivers PPO $5,137.50
Rate for Payer: TriWest Veterans Administration $4,521.00
Rate for Payer: United Healthcare Commercial $5,959.50
Rate for Payer: United Healthcare Medicare $4,521.00
Rate for Payer: WINHealth Partners Commercial $6,507.50
Rate for Payer: Wise Provider Network Commercial $6,507.50
Service Code HCPCS 49180
Hospital Charge Code 4024918001
Hospital Revenue Code 402
Min. Negotiated Rate $3,774.35
Max. Negotiated Rate $6,850.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $6,713.00
Rate for Payer: Aetna of WY Medicare $4,521.00
Rate for Payer: Altius Auto/Workers Compensation $6,576.00
Rate for Payer: Altius Commercial $6,576.00
Rate for Payer: Beech Street Commercial $6,713.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5,623.85
Rate for Payer: Cash Price $4,795.00
Rate for Payer: ChoiceCare Network Commercial $6,644.50
Rate for Payer: Cigna of WY Commercial $6,713.00
Rate for Payer: Entrust Commercial $6,507.50
Rate for Payer: First Choice Health Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,973.00
Rate for Payer: HealthUtah PPO $6,850.00
Rate for Payer: Idaho Integrated Healthcare Commercial $6,644.50
Rate for Payer: Multiplan Medicare/VA $3,774.35
Rate for Payer: One Health Plan of WY PPO $6,713.00
Rate for Payer: PacificSource Commercial $6,165.00
Rate for Payer: PHCS PPO $6,713.00
Rate for Payer: Three Rivers PPO $5,137.50
Rate for Payer: TriWest Veterans Administration $3,973.00
Rate for Payer: United Healthcare Commercial $5,959.50
Rate for Payer: United Healthcare Medicare $3,973.00
Rate for Payer: WINHealth Partners Commercial $6,713.00
Rate for Payer: Wise Provider Network Commercial $6,507.50
Service Code HCPCS 49180
Hospital Charge Code 4024918001
Hospital Revenue Code 402
Min. Negotiated Rate $4,294.95
Max. Negotiated Rate $6,850.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $6,713.00
Rate for Payer: Altius Auto/Workers Compensation $6,576.00
Rate for Payer: Altius Commercial $6,576.00
Rate for Payer: Beech Street Commercial $6,713.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5,623.85
Rate for Payer: Cash Price $4,795.00
Rate for Payer: ChoiceCare Network Commercial $6,644.50
Rate for Payer: Cigna of WY Commercial $6,713.00
Rate for Payer: Entrust Commercial $6,507.50
Rate for Payer: First Choice Health Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6,507.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4,521.00
Rate for Payer: HealthUtah PPO $6,850.00
Rate for Payer: Idaho Integrated Healthcare Commercial $6,644.50
Rate for Payer: Multiplan Medicare/VA $4,294.95
Rate for Payer: One Health Plan of WY PPO $6,713.00
Rate for Payer: PacificSource Commercial $6,165.00
Rate for Payer: PHCS PPO $6,713.00
Rate for Payer: Three Rivers PPO $5,137.50
Rate for Payer: TriWest Veterans Administration $4,521.00
Rate for Payer: United Healthcare Commercial $5,959.50
Rate for Payer: United Healthcare Medicare $4,521.00
Rate for Payer: WINHealth Partners Commercial $6,507.50
Rate for Payer: Wise Provider Network Commercial $6,507.50
Service Code HCPCS 77065
Hospital Charge Code 4027706501
Hospital Revenue Code 402
Min. Negotiated Rate $1,669.53
Max. Negotiated Rate $3,030.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,969.40
Rate for Payer: Aetna of WY Medicare $1,999.80
Rate for Payer: Altius Auto/Workers Compensation $2,908.80
Rate for Payer: Altius Commercial $2,908.80
Rate for Payer: Beech Street Commercial $2,969.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,487.63
Rate for Payer: Cash Price $2,121.00
Rate for Payer: ChoiceCare Network Commercial $2,939.10
Rate for Payer: Cigna of WY Commercial $2,969.40
Rate for Payer: Entrust Commercial $2,878.50
Rate for Payer: First Choice Health Commercial $2,878.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,878.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,757.40
Rate for Payer: HealthUtah PPO $3,030.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,939.10
Rate for Payer: Multiplan Medicare/VA $1,669.53
Rate for Payer: One Health Plan of WY PPO $2,969.40
Rate for Payer: PacificSource Commercial $2,727.00
Rate for Payer: PHCS PPO $2,969.40
Rate for Payer: Three Rivers PPO $2,272.50
Rate for Payer: TriWest Veterans Administration $1,757.40
Rate for Payer: United Healthcare Commercial $2,636.10
Rate for Payer: United Healthcare Medicare $1,757.40
Rate for Payer: WINHealth Partners Commercial $2,969.40
Rate for Payer: Wise Provider Network Commercial $2,878.50
Service Code HCPCS 77065
Hospital Charge Code 4027706501
Hospital Revenue Code 402
Min. Negotiated Rate $1,899.81
Max. Negotiated Rate $3,030.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,969.40
Rate for Payer: Altius Auto/Workers Compensation $2,908.80
Rate for Payer: Altius Commercial $2,908.80
Rate for Payer: Beech Street Commercial $2,969.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,487.63
Rate for Payer: Cash Price $2,121.00
Rate for Payer: ChoiceCare Network Commercial $2,939.10
Rate for Payer: Cigna of WY Commercial $2,969.40
Rate for Payer: Entrust Commercial $2,878.50
Rate for Payer: First Choice Health Commercial $2,878.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,878.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,999.80
Rate for Payer: HealthUtah PPO $3,030.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,939.10
Rate for Payer: Multiplan Medicare/VA $1,899.81
Rate for Payer: One Health Plan of WY PPO $2,969.40
Rate for Payer: PacificSource Commercial $2,727.00
Rate for Payer: PHCS PPO $2,969.40
Rate for Payer: Three Rivers PPO $2,272.50
Rate for Payer: TriWest Veterans Administration $1,999.80
Rate for Payer: United Healthcare Commercial $2,636.10
Rate for Payer: United Healthcare Medicare $1,999.80
Rate for Payer: WINHealth Partners Commercial $2,878.50
Rate for Payer: Wise Provider Network Commercial $2,878.50
Service Code HCPCS 19285
Hospital Charge Code 4021928501
Hospital Revenue Code 402
Min. Negotiated Rate $1,669.53
Max. Negotiated Rate $3,030.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,969.40
Rate for Payer: Aetna of WY Medicare $1,999.80
Rate for Payer: Altius Auto/Workers Compensation $2,908.80
Rate for Payer: Altius Commercial $2,908.80
Rate for Payer: Beech Street Commercial $2,969.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,487.63
Rate for Payer: Cash Price $2,121.00
Rate for Payer: ChoiceCare Network Commercial $2,939.10
Rate for Payer: Cigna of WY Commercial $2,969.40
Rate for Payer: Entrust Commercial $2,878.50
Rate for Payer: First Choice Health Commercial $2,878.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,878.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,757.40
Rate for Payer: HealthUtah PPO $3,030.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,939.10
Rate for Payer: Multiplan Medicare/VA $1,669.53
Rate for Payer: One Health Plan of WY PPO $2,969.40
Rate for Payer: PacificSource Commercial $2,727.00
Rate for Payer: PHCS PPO $2,969.40
Rate for Payer: Three Rivers PPO $2,272.50
Rate for Payer: TriWest Veterans Administration $1,757.40
Rate for Payer: United Healthcare Commercial $2,636.10
Rate for Payer: United Healthcare Medicare $1,757.40
Rate for Payer: WINHealth Partners Commercial $2,969.40
Rate for Payer: Wise Provider Network Commercial $2,878.50
Service Code HCPCS 19285
Hospital Charge Code 4021928501
Hospital Revenue Code 402
Min. Negotiated Rate $1,899.81
Max. Negotiated Rate $3,030.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,969.40
Rate for Payer: Altius Auto/Workers Compensation $2,908.80
Rate for Payer: Altius Commercial $2,908.80
Rate for Payer: Beech Street Commercial $2,969.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,487.63
Rate for Payer: Cash Price $2,121.00
Rate for Payer: ChoiceCare Network Commercial $2,939.10
Rate for Payer: Cigna of WY Commercial $2,969.40
Rate for Payer: Entrust Commercial $2,878.50
Rate for Payer: First Choice Health Commercial $2,878.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,878.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,999.80
Rate for Payer: HealthUtah PPO $3,030.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,939.10
Rate for Payer: Multiplan Medicare/VA $1,899.81
Rate for Payer: One Health Plan of WY PPO $2,969.40
Rate for Payer: PacificSource Commercial $2,727.00
Rate for Payer: PHCS PPO $2,969.40
Rate for Payer: Three Rivers PPO $2,272.50
Rate for Payer: TriWest Veterans Administration $1,999.80
Rate for Payer: United Healthcare Commercial $2,636.10
Rate for Payer: United Healthcare Medicare $1,999.80
Rate for Payer: WINHealth Partners Commercial $2,878.50
Rate for Payer: Wise Provider Network Commercial $2,878.50
Service Code HCPCS 19281
Hospital Charge Code 3201928102
Hospital Revenue Code 320
Min. Negotiated Rate $1,834.83
Max. Negotiated Rate $3,330.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,263.40
Rate for Payer: Aetna of WY Medicare $2,197.80
Rate for Payer: Altius Auto/Workers Compensation $3,196.80
Rate for Payer: Altius Commercial $3,196.80
Rate for Payer: Beech Street Commercial $3,263.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,733.93
Rate for Payer: Cash Price $2,331.00
Rate for Payer: ChoiceCare Network Commercial $3,230.10
Rate for Payer: Cigna of WY Commercial $3,263.40
Rate for Payer: Entrust Commercial $3,163.50
Rate for Payer: First Choice Health Commercial $3,163.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,163.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,931.40
Rate for Payer: HealthUtah PPO $3,330.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,230.10
Rate for Payer: Multiplan Medicare/VA $1,834.83
Rate for Payer: One Health Plan of WY PPO $3,263.40
Rate for Payer: PacificSource Commercial $2,997.00
Rate for Payer: PHCS PPO $3,263.40
Rate for Payer: Three Rivers PPO $2,497.50
Rate for Payer: TriWest Veterans Administration $1,931.40
Rate for Payer: United Healthcare Commercial $2,897.10
Rate for Payer: United Healthcare Medicare $1,931.40
Rate for Payer: WINHealth Partners Commercial $3,263.40
Rate for Payer: Wise Provider Network Commercial $3,163.50
Service Code HCPCS 19281
Hospital Charge Code 3201928102
Hospital Revenue Code 320
Min. Negotiated Rate $2,087.91
Max. Negotiated Rate $3,330.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,263.40
Rate for Payer: Altius Auto/Workers Compensation $3,196.80
Rate for Payer: Altius Commercial $3,196.80
Rate for Payer: Beech Street Commercial $3,263.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,733.93
Rate for Payer: Cash Price $2,331.00
Rate for Payer: ChoiceCare Network Commercial $3,230.10
Rate for Payer: Cigna of WY Commercial $3,263.40
Rate for Payer: Entrust Commercial $3,163.50
Rate for Payer: First Choice Health Commercial $3,163.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,163.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,197.80
Rate for Payer: HealthUtah PPO $3,330.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,230.10
Rate for Payer: Multiplan Medicare/VA $2,087.91
Rate for Payer: One Health Plan of WY PPO $3,263.40
Rate for Payer: PacificSource Commercial $2,997.00
Rate for Payer: PHCS PPO $3,263.40
Rate for Payer: Three Rivers PPO $2,497.50
Rate for Payer: TriWest Veterans Administration $2,197.80
Rate for Payer: United Healthcare Commercial $2,897.10
Rate for Payer: United Healthcare Medicare $2,197.80
Rate for Payer: WINHealth Partners Commercial $3,163.50
Rate for Payer: Wise Provider Network Commercial $3,163.50