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Service Code HCPCS 86148
Hospital Charge Code 3028614803
Hospital Revenue Code 302
Min. Negotiated Rate $106.59
Max. Negotiated Rate $170.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $166.60
Rate for Payer: Altius Auto/Workers Compensation $163.20
Rate for Payer: Altius Commercial $163.20
Rate for Payer: Beech Street Commercial $166.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $139.57
Rate for Payer: Cash Price $119.00
Rate for Payer: ChoiceCare Network Commercial $164.90
Rate for Payer: Cigna of WY Commercial $166.60
Rate for Payer: Entrust Commercial $161.50
Rate for Payer: First Choice Health Commercial $161.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $161.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $112.20
Rate for Payer: HealthUtah PPO $170.00
Rate for Payer: Idaho Integrated Healthcare Commercial $164.90
Rate for Payer: Multiplan Medicare/VA $106.59
Rate for Payer: One Health Plan of WY PPO $166.60
Rate for Payer: PacificSource Commercial $153.00
Rate for Payer: PHCS PPO $166.60
Rate for Payer: Three Rivers PPO $127.50
Rate for Payer: TriWest Veterans Administration $112.20
Rate for Payer: United Healthcare Commercial $147.90
Rate for Payer: United Healthcare Medicare $112.20
Rate for Payer: WINHealth Partners Commercial $161.50
Rate for Payer: Wise Provider Network Commercial $161.50
Service Code HCPCS 97750
Hospital Charge Code 5109775001
Hospital Revenue Code 510
Min. Negotiated Rate $17.56
Max. Negotiated Rate $28.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.44
Rate for Payer: Altius Auto/Workers Compensation $26.88
Rate for Payer: Altius Commercial $26.88
Rate for Payer: Beech Street Commercial $27.44
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $22.99
Rate for Payer: Cash Price $19.60
Rate for Payer: ChoiceCare Network Commercial $27.16
Rate for Payer: Cigna of WY Commercial $27.44
Rate for Payer: Entrust Commercial $26.60
Rate for Payer: First Choice Health Commercial $26.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.48
Rate for Payer: HealthUtah PPO $28.00
Rate for Payer: Idaho Integrated Healthcare Commercial $27.16
Rate for Payer: Multiplan Medicare/VA $17.56
Rate for Payer: One Health Plan of WY PPO $27.44
Rate for Payer: PacificSource Commercial $25.20
Rate for Payer: PHCS PPO $27.44
Rate for Payer: Three Rivers PPO $21.00
Rate for Payer: TriWest Veterans Administration $18.48
Rate for Payer: United Healthcare Commercial $24.36
Rate for Payer: United Healthcare Medicare $18.48
Rate for Payer: WINHealth Partners Commercial $26.60
Rate for Payer: Wise Provider Network Commercial $26.60
Service Code HCPCS 97750
Hospital Charge Code 5109775001
Hospital Revenue Code 510
Min. Negotiated Rate $15.43
Max. Negotiated Rate $28.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.44
Rate for Payer: Aetna of WY Medicare $18.48
Rate for Payer: Altius Auto/Workers Compensation $26.88
Rate for Payer: Altius Commercial $26.88
Rate for Payer: Beech Street Commercial $27.44
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $22.99
Rate for Payer: Cash Price $19.60
Rate for Payer: ChoiceCare Network Commercial $27.16
Rate for Payer: Cigna of WY Commercial $27.44
Rate for Payer: Entrust Commercial $26.60
Rate for Payer: First Choice Health Commercial $26.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.24
Rate for Payer: HealthUtah PPO $28.00
Rate for Payer: Idaho Integrated Healthcare Commercial $27.16
Rate for Payer: Multiplan Medicare/VA $15.43
Rate for Payer: One Health Plan of WY PPO $27.44
Rate for Payer: PacificSource Commercial $25.20
Rate for Payer: PHCS PPO $27.44
Rate for Payer: Three Rivers PPO $21.00
Rate for Payer: TriWest Veterans Administration $16.24
Rate for Payer: United Healthcare Commercial $24.36
Rate for Payer: United Healthcare Medicare $16.24
Rate for Payer: WINHealth Partners Commercial $27.44
Rate for Payer: Wise Provider Network Commercial $26.60
Hospital Charge Code 4200000003
Hospital Revenue Code 420
Min. Negotiated Rate $56.75
Max. Negotiated Rate $103.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $100.94
Rate for Payer: Aetna of WY Medicare $67.98
Rate for Payer: Altius Auto/Workers Compensation $98.88
Rate for Payer: Altius Commercial $98.88
Rate for Payer: Beech Street Commercial $100.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $84.56
Rate for Payer: Cash Price $72.10
Rate for Payer: ChoiceCare Network Commercial $99.91
Rate for Payer: Cigna of WY Commercial $100.94
Rate for Payer: Entrust Commercial $97.85
Rate for Payer: First Choice Health Commercial $97.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $97.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $59.74
Rate for Payer: HealthUtah PPO $103.00
Rate for Payer: Idaho Integrated Healthcare Commercial $99.91
Rate for Payer: Multiplan Medicare/VA $56.75
Rate for Payer: One Health Plan of WY PPO $100.94
Rate for Payer: PacificSource Commercial $92.70
Rate for Payer: PHCS PPO $100.94
Rate for Payer: Three Rivers PPO $77.25
Rate for Payer: TriWest Veterans Administration $59.74
Rate for Payer: United Healthcare Commercial $89.61
Rate for Payer: United Healthcare Medicare $59.74
Rate for Payer: WINHealth Partners Commercial $100.94
Rate for Payer: Wise Provider Network Commercial $97.85
Hospital Charge Code 4200000003
Hospital Revenue Code 420
Min. Negotiated Rate $64.58
Max. Negotiated Rate $103.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $100.94
Rate for Payer: Altius Auto/Workers Compensation $98.88
Rate for Payer: Altius Commercial $98.88
Rate for Payer: Beech Street Commercial $100.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $84.56
Rate for Payer: Cash Price $72.10
Rate for Payer: ChoiceCare Network Commercial $99.91
Rate for Payer: Cigna of WY Commercial $100.94
Rate for Payer: Entrust Commercial $97.85
Rate for Payer: First Choice Health Commercial $97.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $97.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $67.98
Rate for Payer: HealthUtah PPO $103.00
Rate for Payer: Idaho Integrated Healthcare Commercial $99.91
Rate for Payer: Multiplan Medicare/VA $64.58
Rate for Payer: One Health Plan of WY PPO $100.94
Rate for Payer: PacificSource Commercial $92.70
Rate for Payer: PHCS PPO $100.94
Rate for Payer: Three Rivers PPO $77.25
Rate for Payer: TriWest Veterans Administration $67.98
Rate for Payer: United Healthcare Commercial $89.61
Rate for Payer: United Healthcare Medicare $67.98
Rate for Payer: WINHealth Partners Commercial $97.85
Rate for Payer: Wise Provider Network Commercial $97.85
Service Code HCPCS 88304
Hospital Charge Code 3108830403
Hospital Revenue Code 310
Min. Negotiated Rate $220.40
Max. Negotiated Rate $400.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $392.00
Rate for Payer: Aetna of WY Medicare $264.00
Rate for Payer: Altius Auto/Workers Compensation $384.00
Rate for Payer: Altius Commercial $384.00
Rate for Payer: Beech Street Commercial $392.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $328.40
Rate for Payer: Cash Price $280.00
Rate for Payer: ChoiceCare Network Commercial $388.00
Rate for Payer: Cigna of WY Commercial $392.00
Rate for Payer: Entrust Commercial $380.00
Rate for Payer: First Choice Health Commercial $380.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $380.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $232.00
Rate for Payer: HealthUtah PPO $400.00
Rate for Payer: Idaho Integrated Healthcare Commercial $388.00
Rate for Payer: Multiplan Medicare/VA $220.40
Rate for Payer: One Health Plan of WY PPO $392.00
Rate for Payer: PacificSource Commercial $360.00
Rate for Payer: PHCS PPO $392.00
Rate for Payer: Three Rivers PPO $300.00
Rate for Payer: TriWest Veterans Administration $232.00
Rate for Payer: United Healthcare Commercial $348.00
Rate for Payer: United Healthcare Medicare $232.00
Rate for Payer: WINHealth Partners Commercial $392.00
Rate for Payer: Wise Provider Network Commercial $380.00
Service Code HCPCS 88304
Hospital Charge Code 3108830403
Hospital Revenue Code 310
Min. Negotiated Rate $250.80
Max. Negotiated Rate $400.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $392.00
Rate for Payer: Altius Auto/Workers Compensation $384.00
Rate for Payer: Altius Commercial $384.00
Rate for Payer: Beech Street Commercial $392.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $328.40
Rate for Payer: Cash Price $280.00
Rate for Payer: ChoiceCare Network Commercial $388.00
Rate for Payer: Cigna of WY Commercial $392.00
Rate for Payer: Entrust Commercial $380.00
Rate for Payer: First Choice Health Commercial $380.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $380.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $264.00
Rate for Payer: HealthUtah PPO $400.00
Rate for Payer: Idaho Integrated Healthcare Commercial $388.00
Rate for Payer: Multiplan Medicare/VA $250.80
Rate for Payer: One Health Plan of WY PPO $392.00
Rate for Payer: PacificSource Commercial $360.00
Rate for Payer: PHCS PPO $392.00
Rate for Payer: Three Rivers PPO $300.00
Rate for Payer: TriWest Veterans Administration $264.00
Rate for Payer: United Healthcare Commercial $348.00
Rate for Payer: United Healthcare Medicare $264.00
Rate for Payer: WINHealth Partners Commercial $380.00
Rate for Payer: Wise Provider Network Commercial $380.00
Service Code HCPCS 87172
Hospital Charge Code 3068717201
Hospital Revenue Code 306
Min. Negotiated Rate $22.04
Max. Negotiated Rate $40.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $39.20
Rate for Payer: Aetna of WY Medicare $26.40
Rate for Payer: Altius Auto/Workers Compensation $38.40
Rate for Payer: Altius Commercial $38.40
Rate for Payer: Beech Street Commercial $39.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $32.84
Rate for Payer: Cash Price $28.00
Rate for Payer: ChoiceCare Network Commercial $38.80
Rate for Payer: Cigna of WY Commercial $39.20
Rate for Payer: Entrust Commercial $38.00
Rate for Payer: First Choice Health Commercial $38.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $38.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $23.20
Rate for Payer: HealthUtah PPO $40.00
Rate for Payer: Idaho Integrated Healthcare Commercial $38.80
Rate for Payer: Multiplan Medicare/VA $22.04
Rate for Payer: One Health Plan of WY PPO $39.20
Rate for Payer: PacificSource Commercial $36.00
Rate for Payer: PHCS PPO $39.20
Rate for Payer: Three Rivers PPO $30.00
Rate for Payer: TriWest Veterans Administration $23.20
Rate for Payer: United Healthcare Commercial $34.80
Rate for Payer: United Healthcare Medicare $23.20
Rate for Payer: WINHealth Partners Commercial $39.20
Rate for Payer: Wise Provider Network Commercial $38.00
Service Code HCPCS 87172
Hospital Charge Code 3068717201
Hospital Revenue Code 306
Min. Negotiated Rate $25.08
Max. Negotiated Rate $40.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $39.20
Rate for Payer: Altius Auto/Workers Compensation $38.40
Rate for Payer: Altius Commercial $38.40
Rate for Payer: Beech Street Commercial $39.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $32.84
Rate for Payer: Cash Price $28.00
Rate for Payer: ChoiceCare Network Commercial $38.80
Rate for Payer: Cigna of WY Commercial $39.20
Rate for Payer: Entrust Commercial $38.00
Rate for Payer: First Choice Health Commercial $38.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $38.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $26.40
Rate for Payer: HealthUtah PPO $40.00
Rate for Payer: Idaho Integrated Healthcare Commercial $38.80
Rate for Payer: Multiplan Medicare/VA $25.08
Rate for Payer: One Health Plan of WY PPO $39.20
Rate for Payer: PacificSource Commercial $36.00
Rate for Payer: PHCS PPO $39.20
Rate for Payer: Three Rivers PPO $30.00
Rate for Payer: TriWest Veterans Administration $26.40
Rate for Payer: United Healthcare Commercial $34.80
Rate for Payer: United Healthcare Medicare $26.40
Rate for Payer: WINHealth Partners Commercial $38.00
Rate for Payer: Wise Provider Network Commercial $38.00
Service Code HCPCS 36011
Hospital Charge Code 3613601101
Hospital Revenue Code 361
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 36011
Hospital Charge Code 3613601101
Hospital Revenue Code 361
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 43752
Hospital Charge Code 7614375201
Hospital Revenue Code 761
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 43752
Hospital Charge Code 7614375201
Hospital Revenue Code 761
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 43752
Hospital Charge Code 3204375201
Hospital Revenue Code 320
Min. Negotiated Rate $994.56
Max. Negotiated Rate $1,805.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,768.90
Rate for Payer: Aetna of WY Medicare $1,191.30
Rate for Payer: Altius Auto/Workers Compensation $1,732.80
Rate for Payer: Altius Commercial $1,732.80
Rate for Payer: Beech Street Commercial $1,768.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,481.90
Rate for Payer: Cash Price $1,263.50
Rate for Payer: ChoiceCare Network Commercial $1,750.85
Rate for Payer: Cigna of WY Commercial $1,768.90
Rate for Payer: Entrust Commercial $1,714.75
Rate for Payer: First Choice Health Commercial $1,714.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,714.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,046.90
Rate for Payer: HealthUtah PPO $1,805.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,750.85
Rate for Payer: Multiplan Medicare/VA $994.56
Rate for Payer: One Health Plan of WY PPO $1,768.90
Rate for Payer: PacificSource Commercial $1,624.50
Rate for Payer: PHCS PPO $1,768.90
Rate for Payer: Three Rivers PPO $1,353.75
Rate for Payer: TriWest Veterans Administration $1,046.90
Rate for Payer: United Healthcare Commercial $1,570.35
Rate for Payer: United Healthcare Medicare $1,046.90
Rate for Payer: WINHealth Partners Commercial $1,768.90
Rate for Payer: Wise Provider Network Commercial $1,714.75
Service Code HCPCS 43752
Hospital Charge Code 3204375201
Hospital Revenue Code 320
Min. Negotiated Rate $1,131.74
Max. Negotiated Rate $1,805.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,768.90
Rate for Payer: Altius Auto/Workers Compensation $1,732.80
Rate for Payer: Altius Commercial $1,732.80
Rate for Payer: Beech Street Commercial $1,768.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,481.90
Rate for Payer: Cash Price $1,263.50
Rate for Payer: ChoiceCare Network Commercial $1,750.85
Rate for Payer: Cigna of WY Commercial $1,768.90
Rate for Payer: Entrust Commercial $1,714.75
Rate for Payer: First Choice Health Commercial $1,714.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,714.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,191.30
Rate for Payer: HealthUtah PPO $1,805.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,750.85
Rate for Payer: Multiplan Medicare/VA $1,131.74
Rate for Payer: One Health Plan of WY PPO $1,768.90
Rate for Payer: PacificSource Commercial $1,624.50
Rate for Payer: PHCS PPO $1,768.90
Rate for Payer: Three Rivers PPO $1,353.75
Rate for Payer: TriWest Veterans Administration $1,191.30
Rate for Payer: United Healthcare Commercial $1,570.35
Rate for Payer: United Healthcare Medicare $1,191.30
Rate for Payer: WINHealth Partners Commercial $1,714.75
Rate for Payer: Wise Provider Network Commercial $1,714.75
Service Code HCPCS 36000
Hospital Charge Code 3613600001
Hospital Revenue Code 361
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 36000
Hospital Charge Code 3613600001
Hospital Revenue Code 361
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 84112
Hospital Charge Code 3018411201
Hospital Revenue Code 301
Min. Negotiated Rate $482.12
Max. Negotiated Rate $875.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $857.50
Rate for Payer: Aetna of WY Medicare $577.50
Rate for Payer: Altius Auto/Workers Compensation $840.00
Rate for Payer: Altius Commercial $840.00
Rate for Payer: Beech Street Commercial $857.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $718.38
Rate for Payer: Cash Price $612.50
Rate for Payer: ChoiceCare Network Commercial $848.75
Rate for Payer: Cigna of WY Commercial $857.50
Rate for Payer: Entrust Commercial $831.25
Rate for Payer: First Choice Health Commercial $831.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $831.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $507.50
Rate for Payer: HealthUtah PPO $875.00
Rate for Payer: Idaho Integrated Healthcare Commercial $848.75
Rate for Payer: Multiplan Medicare/VA $482.12
Rate for Payer: One Health Plan of WY PPO $857.50
Rate for Payer: PacificSource Commercial $787.50
Rate for Payer: PHCS PPO $857.50
Rate for Payer: Three Rivers PPO $656.25
Rate for Payer: TriWest Veterans Administration $507.50
Rate for Payer: United Healthcare Commercial $761.25
Rate for Payer: United Healthcare Medicare $507.50
Rate for Payer: WINHealth Partners Commercial $857.50
Rate for Payer: Wise Provider Network Commercial $831.25
Service Code HCPCS 84112
Hospital Charge Code 3018411201
Hospital Revenue Code 301
Min. Negotiated Rate $548.62
Max. Negotiated Rate $875.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $857.50
Rate for Payer: Altius Auto/Workers Compensation $840.00
Rate for Payer: Altius Commercial $840.00
Rate for Payer: Beech Street Commercial $857.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $718.38
Rate for Payer: Cash Price $612.50
Rate for Payer: ChoiceCare Network Commercial $848.75
Rate for Payer: Cigna of WY Commercial $857.50
Rate for Payer: Entrust Commercial $831.25
Rate for Payer: First Choice Health Commercial $831.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $831.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $577.50
Rate for Payer: HealthUtah PPO $875.00
Rate for Payer: Idaho Integrated Healthcare Commercial $848.75
Rate for Payer: Multiplan Medicare/VA $548.62
Rate for Payer: One Health Plan of WY PPO $857.50
Rate for Payer: PacificSource Commercial $787.50
Rate for Payer: PHCS PPO $857.50
Rate for Payer: Three Rivers PPO $656.25
Rate for Payer: TriWest Veterans Administration $577.50
Rate for Payer: United Healthcare Commercial $761.25
Rate for Payer: United Healthcare Medicare $577.50
Rate for Payer: WINHealth Partners Commercial $831.25
Rate for Payer: Wise Provider Network Commercial $831.25
Service Code HCPCS 86022
Hospital Charge Code 3028602204
Hospital Revenue Code 302
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 86022
Hospital Charge Code 3028602204
Hospital Revenue Code 302
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 86022
Hospital Charge Code 3028602203
Hospital Revenue Code 302
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 86022
Hospital Charge Code 3028602203
Hospital Revenue Code 302
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 86022
Hospital Charge Code 3028602205
Hospital Revenue Code 302
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 86022
Hospital Charge Code 3028602205
Hospital Revenue Code 302
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