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Service Code HCPCS 85049
Hospital Charge Code 3058504902
Hospital Revenue Code 305
Min. Negotiated Rate $63.36
Max. Negotiated Rate $115.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $112.70
Rate for Payer: Aetna of WY Medicare $75.90
Rate for Payer: Altius Auto/Workers Compensation $110.40
Rate for Payer: Altius Commercial $110.40
Rate for Payer: Beech Street Commercial $112.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $94.42
Rate for Payer: Cash Price $80.50
Rate for Payer: ChoiceCare Network Commercial $111.55
Rate for Payer: Cigna of WY Commercial $112.70
Rate for Payer: Entrust Commercial $109.25
Rate for Payer: First Choice Health Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.70
Rate for Payer: HealthUtah PPO $115.00
Rate for Payer: Idaho Integrated Healthcare Commercial $111.55
Rate for Payer: Multiplan Medicare/VA $63.36
Rate for Payer: One Health Plan of WY PPO $112.70
Rate for Payer: PacificSource Commercial $103.50
Rate for Payer: PHCS PPO $112.70
Rate for Payer: Three Rivers PPO $86.25
Rate for Payer: TriWest Veterans Administration $66.70
Rate for Payer: United Healthcare Commercial $100.05
Rate for Payer: United Healthcare Medicare $66.70
Rate for Payer: WINHealth Partners Commercial $112.70
Rate for Payer: Wise Provider Network Commercial $109.25
Service Code HCPCS 85049
Hospital Charge Code 3058504902
Hospital Revenue Code 305
Min. Negotiated Rate $72.10
Max. Negotiated Rate $115.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $112.70
Rate for Payer: Altius Auto/Workers Compensation $110.40
Rate for Payer: Altius Commercial $110.40
Rate for Payer: Beech Street Commercial $112.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $94.42
Rate for Payer: Cash Price $80.50
Rate for Payer: ChoiceCare Network Commercial $111.55
Rate for Payer: Cigna of WY Commercial $112.70
Rate for Payer: Entrust Commercial $109.25
Rate for Payer: First Choice Health Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $109.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $75.90
Rate for Payer: HealthUtah PPO $115.00
Rate for Payer: Idaho Integrated Healthcare Commercial $111.55
Rate for Payer: Multiplan Medicare/VA $72.10
Rate for Payer: One Health Plan of WY PPO $112.70
Rate for Payer: PacificSource Commercial $103.50
Rate for Payer: PHCS PPO $112.70
Rate for Payer: Three Rivers PPO $86.25
Rate for Payer: TriWest Veterans Administration $75.90
Rate for Payer: United Healthcare Commercial $100.05
Rate for Payer: United Healthcare Medicare $75.90
Rate for Payer: WINHealth Partners Commercial $109.25
Rate for Payer: Wise Provider Network Commercial $109.25
Service Code HCPCS P9073
Hospital Charge Code 390P907301
Hospital Revenue Code 390
Min. Negotiated Rate $1,137.82
Max. Negotiated Rate $2,065.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,023.70
Rate for Payer: Aetna of WY Medicare $1,362.90
Rate for Payer: Altius Auto/Workers Compensation $1,982.40
Rate for Payer: Altius Commercial $1,982.40
Rate for Payer: Beech Street Commercial $2,023.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,695.36
Rate for Payer: Cash Price $1,445.50
Rate for Payer: ChoiceCare Network Commercial $2,003.05
Rate for Payer: Cigna of WY Commercial $2,023.70
Rate for Payer: Entrust Commercial $1,961.75
Rate for Payer: First Choice Health Commercial $1,961.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,961.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,197.70
Rate for Payer: HealthUtah PPO $2,065.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,003.05
Rate for Payer: Multiplan Medicare/VA $1,137.82
Rate for Payer: One Health Plan of WY PPO $2,023.70
Rate for Payer: PacificSource Commercial $1,858.50
Rate for Payer: PHCS PPO $2,023.70
Rate for Payer: Three Rivers PPO $1,548.75
Rate for Payer: TriWest Veterans Administration $1,197.70
Rate for Payer: United Healthcare Commercial $1,796.55
Rate for Payer: United Healthcare Medicare $1,197.70
Rate for Payer: WINHealth Partners Commercial $2,023.70
Rate for Payer: Wise Provider Network Commercial $1,961.75
Service Code HCPCS P9073
Hospital Charge Code 390P907301
Hospital Revenue Code 390
Min. Negotiated Rate $1,294.76
Max. Negotiated Rate $2,065.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,023.70
Rate for Payer: Altius Auto/Workers Compensation $1,982.40
Rate for Payer: Altius Commercial $1,982.40
Rate for Payer: Beech Street Commercial $2,023.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,695.36
Rate for Payer: Cash Price $1,445.50
Rate for Payer: ChoiceCare Network Commercial $2,003.05
Rate for Payer: Cigna of WY Commercial $2,023.70
Rate for Payer: Entrust Commercial $1,961.75
Rate for Payer: First Choice Health Commercial $1,961.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,961.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,362.90
Rate for Payer: HealthUtah PPO $2,065.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,003.05
Rate for Payer: Multiplan Medicare/VA $1,294.76
Rate for Payer: One Health Plan of WY PPO $2,023.70
Rate for Payer: PacificSource Commercial $1,858.50
Rate for Payer: PHCS PPO $2,023.70
Rate for Payer: Three Rivers PPO $1,548.75
Rate for Payer: TriWest Veterans Administration $1,362.90
Rate for Payer: United Healthcare Commercial $1,796.55
Rate for Payer: United Healthcare Medicare $1,362.90
Rate for Payer: WINHealth Partners Commercial $1,961.75
Rate for Payer: Wise Provider Network Commercial $1,961.75
Service Code HCPCS 81319
Hospital Charge Code 3108131901
Hospital Revenue Code 310
Min. Negotiated Rate $1,000.06
Max. Negotiated Rate $1,815.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,778.70
Rate for Payer: Aetna of WY Medicare $1,197.90
Rate for Payer: Altius Auto/Workers Compensation $1,742.40
Rate for Payer: Altius Commercial $1,742.40
Rate for Payer: Beech Street Commercial $1,778.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,490.12
Rate for Payer: Cash Price $1,270.50
Rate for Payer: ChoiceCare Network Commercial $1,760.55
Rate for Payer: Cigna of WY Commercial $1,778.70
Rate for Payer: Entrust Commercial $1,724.25
Rate for Payer: First Choice Health Commercial $1,724.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,724.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,052.70
Rate for Payer: HealthUtah PPO $1,815.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,760.55
Rate for Payer: Multiplan Medicare/VA $1,000.06
Rate for Payer: One Health Plan of WY PPO $1,778.70
Rate for Payer: PacificSource Commercial $1,633.50
Rate for Payer: PHCS PPO $1,778.70
Rate for Payer: Three Rivers PPO $1,361.25
Rate for Payer: TriWest Veterans Administration $1,052.70
Rate for Payer: United Healthcare Commercial $1,579.05
Rate for Payer: United Healthcare Medicare $1,052.70
Rate for Payer: WINHealth Partners Commercial $1,778.70
Rate for Payer: Wise Provider Network Commercial $1,724.25
Service Code HCPCS 81319
Hospital Charge Code 3108131901
Hospital Revenue Code 310
Min. Negotiated Rate $1,138.00
Max. Negotiated Rate $1,815.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,778.70
Rate for Payer: Altius Auto/Workers Compensation $1,742.40
Rate for Payer: Altius Commercial $1,742.40
Rate for Payer: Beech Street Commercial $1,778.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,490.12
Rate for Payer: Cash Price $1,270.50
Rate for Payer: ChoiceCare Network Commercial $1,760.55
Rate for Payer: Cigna of WY Commercial $1,778.70
Rate for Payer: Entrust Commercial $1,724.25
Rate for Payer: First Choice Health Commercial $1,724.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,724.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,197.90
Rate for Payer: HealthUtah PPO $1,815.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,760.55
Rate for Payer: Multiplan Medicare/VA $1,138.00
Rate for Payer: One Health Plan of WY PPO $1,778.70
Rate for Payer: PacificSource Commercial $1,633.50
Rate for Payer: PHCS PPO $1,778.70
Rate for Payer: Three Rivers PPO $1,361.25
Rate for Payer: TriWest Veterans Administration $1,197.90
Rate for Payer: United Healthcare Commercial $1,579.05
Rate for Payer: United Healthcare Medicare $1,197.90
Rate for Payer: WINHealth Partners Commercial $1,724.25
Rate for Payer: Wise Provider Network Commercial $1,724.25
Service Code HCPCS 81317
Hospital Charge Code 3108131701
Hospital Revenue Code 310
Min. Negotiated Rate $1,664.02
Max. Negotiated Rate $3,020.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,959.60
Rate for Payer: Aetna of WY Medicare $1,993.20
Rate for Payer: Altius Auto/Workers Compensation $2,899.20
Rate for Payer: Altius Commercial $2,899.20
Rate for Payer: Beech Street Commercial $2,959.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,479.42
Rate for Payer: Cash Price $2,114.00
Rate for Payer: ChoiceCare Network Commercial $2,929.40
Rate for Payer: Cigna of WY Commercial $2,959.60
Rate for Payer: Entrust Commercial $2,869.00
Rate for Payer: First Choice Health Commercial $2,869.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,869.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,751.60
Rate for Payer: HealthUtah PPO $3,020.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,929.40
Rate for Payer: Multiplan Medicare/VA $1,664.02
Rate for Payer: One Health Plan of WY PPO $2,959.60
Rate for Payer: PacificSource Commercial $2,718.00
Rate for Payer: PHCS PPO $2,959.60
Rate for Payer: Three Rivers PPO $2,265.00
Rate for Payer: TriWest Veterans Administration $1,751.60
Rate for Payer: United Healthcare Commercial $2,627.40
Rate for Payer: United Healthcare Medicare $1,751.60
Rate for Payer: WINHealth Partners Commercial $2,959.60
Rate for Payer: Wise Provider Network Commercial $2,869.00
Service Code HCPCS 81317
Hospital Charge Code 3108131701
Hospital Revenue Code 310
Min. Negotiated Rate $1,893.54
Max. Negotiated Rate $3,020.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,959.60
Rate for Payer: Altius Auto/Workers Compensation $2,899.20
Rate for Payer: Altius Commercial $2,899.20
Rate for Payer: Beech Street Commercial $2,959.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,479.42
Rate for Payer: Cash Price $2,114.00
Rate for Payer: ChoiceCare Network Commercial $2,929.40
Rate for Payer: Cigna of WY Commercial $2,959.60
Rate for Payer: Entrust Commercial $2,869.00
Rate for Payer: First Choice Health Commercial $2,869.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,869.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,993.20
Rate for Payer: HealthUtah PPO $3,020.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,929.40
Rate for Payer: Multiplan Medicare/VA $1,893.54
Rate for Payer: One Health Plan of WY PPO $2,959.60
Rate for Payer: PacificSource Commercial $2,718.00
Rate for Payer: PHCS PPO $2,959.60
Rate for Payer: Three Rivers PPO $2,265.00
Rate for Payer: TriWest Veterans Administration $1,993.20
Rate for Payer: United Healthcare Commercial $2,627.40
Rate for Payer: United Healthcare Medicare $1,993.20
Rate for Payer: WINHealth Partners Commercial $2,869.00
Rate for Payer: Wise Provider Network Commercial $2,869.00
Service Code HCPCS 87281
Hospital Charge Code 3068728101
Hospital Revenue Code 306
Min. Negotiated Rate $74.38
Max. Negotiated Rate $135.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $132.30
Rate for Payer: Aetna of WY Medicare $89.10
Rate for Payer: Altius Auto/Workers Compensation $129.60
Rate for Payer: Altius Commercial $129.60
Rate for Payer: Beech Street Commercial $132.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $110.84
Rate for Payer: Cash Price $94.50
Rate for Payer: ChoiceCare Network Commercial $130.95
Rate for Payer: Cigna of WY Commercial $132.30
Rate for Payer: Entrust Commercial $128.25
Rate for Payer: First Choice Health Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $78.30
Rate for Payer: HealthUtah PPO $135.00
Rate for Payer: Idaho Integrated Healthcare Commercial $130.95
Rate for Payer: Multiplan Medicare/VA $74.38
Rate for Payer: One Health Plan of WY PPO $132.30
Rate for Payer: PacificSource Commercial $121.50
Rate for Payer: PHCS PPO $132.30
Rate for Payer: Three Rivers PPO $101.25
Rate for Payer: TriWest Veterans Administration $78.30
Rate for Payer: United Healthcare Commercial $117.45
Rate for Payer: United Healthcare Medicare $78.30
Rate for Payer: WINHealth Partners Commercial $132.30
Rate for Payer: Wise Provider Network Commercial $128.25
Service Code HCPCS 87281
Hospital Charge Code 3068728101
Hospital Revenue Code 306
Min. Negotiated Rate $84.64
Max. Negotiated Rate $135.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $132.30
Rate for Payer: Altius Auto/Workers Compensation $129.60
Rate for Payer: Altius Commercial $129.60
Rate for Payer: Beech Street Commercial $132.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $110.84
Rate for Payer: Cash Price $94.50
Rate for Payer: ChoiceCare Network Commercial $130.95
Rate for Payer: Cigna of WY Commercial $132.30
Rate for Payer: Entrust Commercial $128.25
Rate for Payer: First Choice Health Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $89.10
Rate for Payer: HealthUtah PPO $135.00
Rate for Payer: Idaho Integrated Healthcare Commercial $130.95
Rate for Payer: Multiplan Medicare/VA $84.64
Rate for Payer: One Health Plan of WY PPO $132.30
Rate for Payer: PacificSource Commercial $121.50
Rate for Payer: PHCS PPO $132.30
Rate for Payer: Three Rivers PPO $101.25
Rate for Payer: TriWest Veterans Administration $89.10
Rate for Payer: United Healthcare Commercial $117.45
Rate for Payer: United Healthcare Medicare $89.10
Rate for Payer: WINHealth Partners Commercial $128.25
Rate for Payer: Wise Provider Network Commercial $128.25
Service Code HCPCS 95810
Hospital Charge Code 7409581001
Hospital Revenue Code 740
Min. Negotiated Rate $3,385.80
Max. Negotiated Rate $5,400.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,292.00
Rate for Payer: Altius Auto/Workers Compensation $5,184.00
Rate for Payer: Altius Commercial $5,184.00
Rate for Payer: Beech Street Commercial $5,292.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,433.40
Rate for Payer: Cash Price $3,780.00
Rate for Payer: ChoiceCare Network Commercial $5,238.00
Rate for Payer: Cigna of WY Commercial $5,292.00
Rate for Payer: Entrust Commercial $5,130.00
Rate for Payer: First Choice Health Commercial $5,130.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,130.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,564.00
Rate for Payer: HealthUtah PPO $5,400.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,238.00
Rate for Payer: Multiplan Medicare/VA $3,385.80
Rate for Payer: One Health Plan of WY PPO $5,292.00
Rate for Payer: PacificSource Commercial $4,860.00
Rate for Payer: PHCS PPO $5,292.00
Rate for Payer: Three Rivers PPO $4,050.00
Rate for Payer: TriWest Veterans Administration $3,564.00
Rate for Payer: United Healthcare Commercial $4,698.00
Rate for Payer: United Healthcare Medicare $3,564.00
Rate for Payer: WINHealth Partners Commercial $5,130.00
Rate for Payer: Wise Provider Network Commercial $5,130.00
Service Code HCPCS 95810
Hospital Charge Code 7409581001
Hospital Revenue Code 740
Min. Negotiated Rate $2,975.40
Max. Negotiated Rate $5,400.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,292.00
Rate for Payer: Aetna of WY Medicare $3,564.00
Rate for Payer: Altius Auto/Workers Compensation $5,184.00
Rate for Payer: Altius Commercial $5,184.00
Rate for Payer: Beech Street Commercial $5,292.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,433.40
Rate for Payer: Cash Price $3,780.00
Rate for Payer: ChoiceCare Network Commercial $5,238.00
Rate for Payer: Cigna of WY Commercial $5,292.00
Rate for Payer: Entrust Commercial $5,130.00
Rate for Payer: First Choice Health Commercial $5,130.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,130.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,132.00
Rate for Payer: HealthUtah PPO $5,400.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,238.00
Rate for Payer: Multiplan Medicare/VA $2,975.40
Rate for Payer: One Health Plan of WY PPO $5,292.00
Rate for Payer: PacificSource Commercial $4,860.00
Rate for Payer: PHCS PPO $5,292.00
Rate for Payer: Three Rivers PPO $4,050.00
Rate for Payer: TriWest Veterans Administration $3,132.00
Rate for Payer: United Healthcare Commercial $4,698.00
Rate for Payer: United Healthcare Medicare $3,132.00
Rate for Payer: WINHealth Partners Commercial $5,292.00
Rate for Payer: Wise Provider Network Commercial $5,130.00
Service Code HCPCS 95811
Hospital Charge Code 7409581101
Hospital Revenue Code 740
Min. Negotiated Rate $3,278.45
Max. Negotiated Rate $5,950.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,831.00
Rate for Payer: Aetna of WY Medicare $3,927.00
Rate for Payer: Altius Auto/Workers Compensation $5,712.00
Rate for Payer: Altius Commercial $5,712.00
Rate for Payer: Beech Street Commercial $5,831.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,884.95
Rate for Payer: Cash Price $4,165.00
Rate for Payer: ChoiceCare Network Commercial $5,771.50
Rate for Payer: Cigna of WY Commercial $5,831.00
Rate for Payer: Entrust Commercial $5,652.50
Rate for Payer: First Choice Health Commercial $5,652.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,652.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,451.00
Rate for Payer: HealthUtah PPO $5,950.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,771.50
Rate for Payer: Multiplan Medicare/VA $3,278.45
Rate for Payer: One Health Plan of WY PPO $5,831.00
Rate for Payer: PacificSource Commercial $5,355.00
Rate for Payer: PHCS PPO $5,831.00
Rate for Payer: Three Rivers PPO $4,462.50
Rate for Payer: TriWest Veterans Administration $3,451.00
Rate for Payer: United Healthcare Commercial $5,176.50
Rate for Payer: United Healthcare Medicare $3,451.00
Rate for Payer: WINHealth Partners Commercial $5,831.00
Rate for Payer: Wise Provider Network Commercial $5,652.50
Service Code HCPCS 95811
Hospital Charge Code 7409581101
Hospital Revenue Code 740
Min. Negotiated Rate $3,730.65
Max. Negotiated Rate $5,950.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,831.00
Rate for Payer: Altius Auto/Workers Compensation $5,712.00
Rate for Payer: Altius Commercial $5,712.00
Rate for Payer: Beech Street Commercial $5,831.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,884.95
Rate for Payer: Cash Price $4,165.00
Rate for Payer: ChoiceCare Network Commercial $5,771.50
Rate for Payer: Cigna of WY Commercial $5,831.00
Rate for Payer: Entrust Commercial $5,652.50
Rate for Payer: First Choice Health Commercial $5,652.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,652.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,927.00
Rate for Payer: HealthUtah PPO $5,950.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,771.50
Rate for Payer: Multiplan Medicare/VA $3,730.65
Rate for Payer: One Health Plan of WY PPO $5,831.00
Rate for Payer: PacificSource Commercial $5,355.00
Rate for Payer: PHCS PPO $5,831.00
Rate for Payer: Three Rivers PPO $4,462.50
Rate for Payer: TriWest Veterans Administration $3,927.00
Rate for Payer: United Healthcare Commercial $5,176.50
Rate for Payer: United Healthcare Medicare $3,927.00
Rate for Payer: WINHealth Partners Commercial $5,652.50
Rate for Payer: Wise Provider Network Commercial $5,652.50
Service Code HCPCS 84120
Hospital Charge Code 3018412001
Hospital Revenue Code 301
Min. Negotiated Rate $112.96
Max. Negotiated Rate $205.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $200.90
Rate for Payer: Aetna of WY Medicare $135.30
Rate for Payer: Altius Auto/Workers Compensation $196.80
Rate for Payer: Altius Commercial $196.80
Rate for Payer: Beech Street Commercial $200.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $168.30
Rate for Payer: Cash Price $143.50
Rate for Payer: ChoiceCare Network Commercial $198.85
Rate for Payer: Cigna of WY Commercial $200.90
Rate for Payer: Entrust Commercial $194.75
Rate for Payer: First Choice Health Commercial $194.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $194.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $118.90
Rate for Payer: HealthUtah PPO $205.00
Rate for Payer: Idaho Integrated Healthcare Commercial $198.85
Rate for Payer: Multiplan Medicare/VA $112.96
Rate for Payer: One Health Plan of WY PPO $200.90
Rate for Payer: PacificSource Commercial $184.50
Rate for Payer: PHCS PPO $200.90
Rate for Payer: Three Rivers PPO $153.75
Rate for Payer: TriWest Veterans Administration $118.90
Rate for Payer: United Healthcare Commercial $178.35
Rate for Payer: United Healthcare Medicare $118.90
Rate for Payer: WINHealth Partners Commercial $200.90
Rate for Payer: Wise Provider Network Commercial $194.75
Service Code HCPCS 84120
Hospital Charge Code 3018412001
Hospital Revenue Code 301
Min. Negotiated Rate $128.54
Max. Negotiated Rate $205.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $200.90
Rate for Payer: Altius Auto/Workers Compensation $196.80
Rate for Payer: Altius Commercial $196.80
Rate for Payer: Beech Street Commercial $200.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $168.30
Rate for Payer: Cash Price $143.50
Rate for Payer: ChoiceCare Network Commercial $198.85
Rate for Payer: Cigna of WY Commercial $200.90
Rate for Payer: Entrust Commercial $194.75
Rate for Payer: First Choice Health Commercial $194.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $194.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $135.30
Rate for Payer: HealthUtah PPO $205.00
Rate for Payer: Idaho Integrated Healthcare Commercial $198.85
Rate for Payer: Multiplan Medicare/VA $128.54
Rate for Payer: One Health Plan of WY PPO $200.90
Rate for Payer: PacificSource Commercial $184.50
Rate for Payer: PHCS PPO $200.90
Rate for Payer: Three Rivers PPO $153.75
Rate for Payer: TriWest Veterans Administration $135.30
Rate for Payer: United Healthcare Commercial $178.35
Rate for Payer: United Healthcare Medicare $135.30
Rate for Payer: WINHealth Partners Commercial $194.75
Rate for Payer: Wise Provider Network Commercial $194.75
Service Code HCPCS 59430
Hospital Charge Code 5105943001
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 59430
Hospital Charge Code 5105943001
Hospital Revenue Code 510
Min. Negotiated Rate $44.63
Max. Negotiated Rate $81.00
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: 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 $81.00
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 15734
Hospital Charge Code 9831573401
Hospital Revenue Code 983
Min. Negotiated Rate $3,202.09
Max. Negotiated Rate $5,107.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,004.86
Rate for Payer: Altius Auto/Workers Compensation $4,902.72
Rate for Payer: Altius Commercial $4,902.72
Rate for Payer: Beech Street Commercial $5,004.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,192.85
Rate for Payer: Cash Price $3,574.90
Rate for Payer: ChoiceCare Network Commercial $4,953.79
Rate for Payer: Cigna of WY Commercial $5,004.86
Rate for Payer: Entrust Commercial $4,851.65
Rate for Payer: First Choice Health Commercial $4,851.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,851.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,370.62
Rate for Payer: HealthUtah PPO $5,107.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,953.79
Rate for Payer: Multiplan Medicare/VA $3,202.09
Rate for Payer: One Health Plan of WY PPO $5,004.86
Rate for Payer: PacificSource Commercial $4,596.30
Rate for Payer: PHCS PPO $5,004.86
Rate for Payer: Three Rivers PPO $3,830.25
Rate for Payer: TriWest Veterans Administration $3,370.62
Rate for Payer: United Healthcare Commercial $4,443.09
Rate for Payer: United Healthcare Medicare $3,370.62
Rate for Payer: WINHealth Partners Commercial $4,851.65
Rate for Payer: Wise Provider Network Commercial $4,851.65
Service Code HCPCS 15734
Hospital Charge Code 9831573401
Hospital Revenue Code 983
Min. Negotiated Rate $2,813.96
Max. Negotiated Rate $5,107.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,004.86
Rate for Payer: Aetna of WY Medicare $3,370.62
Rate for Payer: Altius Auto/Workers Compensation $4,902.72
Rate for Payer: Altius Commercial $4,902.72
Rate for Payer: Beech Street Commercial $5,004.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,192.85
Rate for Payer: Cash Price $3,574.90
Rate for Payer: ChoiceCare Network Commercial $4,953.79
Rate for Payer: Cigna of WY Commercial $5,004.86
Rate for Payer: Entrust Commercial $4,851.65
Rate for Payer: First Choice Health Commercial $4,851.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,851.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,962.06
Rate for Payer: HealthUtah PPO $5,107.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,953.79
Rate for Payer: Multiplan Medicare/VA $2,813.96
Rate for Payer: One Health Plan of WY PPO $5,004.86
Rate for Payer: PacificSource Commercial $4,596.30
Rate for Payer: PHCS PPO $5,004.86
Rate for Payer: Three Rivers PPO $3,830.25
Rate for Payer: TriWest Veterans Administration $2,962.06
Rate for Payer: United Healthcare Commercial $4,443.09
Rate for Payer: United Healthcare Medicare $2,962.06
Rate for Payer: WINHealth Partners Commercial $5,004.86
Rate for Payer: Wise Provider Network Commercial $4,851.65
Service Code HCPCS 19020
Hospital Charge Code 9821902002
Hospital Revenue Code 982
Min. Negotiated Rate $874.44
Max. Negotiated Rate $1,587.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,555.26
Rate for Payer: Aetna of WY Medicare $1,047.42
Rate for Payer: Altius Auto/Workers Compensation $1,523.52
Rate for Payer: Altius Commercial $1,523.52
Rate for Payer: Beech Street Commercial $1,555.26
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,302.93
Rate for Payer: Cash Price $1,110.90
Rate for Payer: ChoiceCare Network Commercial $1,539.39
Rate for Payer: Cigna of WY Commercial $1,555.26
Rate for Payer: Entrust Commercial $1,507.65
Rate for Payer: First Choice Health Commercial $1,507.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,507.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $920.46
Rate for Payer: HealthUtah PPO $1,587.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,539.39
Rate for Payer: Multiplan Medicare/VA $874.44
Rate for Payer: One Health Plan of WY PPO $1,555.26
Rate for Payer: PacificSource Commercial $1,428.30
Rate for Payer: PHCS PPO $1,555.26
Rate for Payer: Three Rivers PPO $1,190.25
Rate for Payer: TriWest Veterans Administration $920.46
Rate for Payer: United Healthcare Commercial $1,380.69
Rate for Payer: United Healthcare Medicare $920.46
Rate for Payer: WINHealth Partners Commercial $1,555.26
Rate for Payer: Wise Provider Network Commercial $1,507.65
Service Code HCPCS 19020
Hospital Charge Code 9821902002
Hospital Revenue Code 982
Min. Negotiated Rate $995.05
Max. Negotiated Rate $1,587.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,555.26
Rate for Payer: Altius Auto/Workers Compensation $1,523.52
Rate for Payer: Altius Commercial $1,523.52
Rate for Payer: Beech Street Commercial $1,555.26
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,302.93
Rate for Payer: Cash Price $1,110.90
Rate for Payer: ChoiceCare Network Commercial $1,539.39
Rate for Payer: Cigna of WY Commercial $1,555.26
Rate for Payer: Entrust Commercial $1,507.65
Rate for Payer: First Choice Health Commercial $1,507.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,507.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,047.42
Rate for Payer: HealthUtah PPO $1,587.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,539.39
Rate for Payer: Multiplan Medicare/VA $995.05
Rate for Payer: One Health Plan of WY PPO $1,555.26
Rate for Payer: PacificSource Commercial $1,428.30
Rate for Payer: PHCS PPO $1,555.26
Rate for Payer: Three Rivers PPO $1,190.25
Rate for Payer: TriWest Veterans Administration $1,047.42
Rate for Payer: United Healthcare Commercial $1,380.69
Rate for Payer: United Healthcare Medicare $1,047.42
Rate for Payer: WINHealth Partners Commercial $1,507.65
Rate for Payer: Wise Provider Network Commercial $1,507.65
Service Code HCPCS 84163
Hospital Charge Code 3018416301
Hospital Revenue Code 301
Min. Negotiated Rate $74.38
Max. Negotiated Rate $135.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $132.30
Rate for Payer: Aetna of WY Medicare $89.10
Rate for Payer: Altius Auto/Workers Compensation $129.60
Rate for Payer: Altius Commercial $129.60
Rate for Payer: Beech Street Commercial $132.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $110.84
Rate for Payer: Cash Price $94.50
Rate for Payer: ChoiceCare Network Commercial $130.95
Rate for Payer: Cigna of WY Commercial $132.30
Rate for Payer: Entrust Commercial $128.25
Rate for Payer: First Choice Health Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $78.30
Rate for Payer: HealthUtah PPO $135.00
Rate for Payer: Idaho Integrated Healthcare Commercial $130.95
Rate for Payer: Multiplan Medicare/VA $74.38
Rate for Payer: One Health Plan of WY PPO $132.30
Rate for Payer: PacificSource Commercial $121.50
Rate for Payer: PHCS PPO $132.30
Rate for Payer: Three Rivers PPO $101.25
Rate for Payer: TriWest Veterans Administration $78.30
Rate for Payer: United Healthcare Commercial $117.45
Rate for Payer: United Healthcare Medicare $78.30
Rate for Payer: WINHealth Partners Commercial $132.30
Rate for Payer: Wise Provider Network Commercial $128.25
Service Code HCPCS 84163
Hospital Charge Code 3018416301
Hospital Revenue Code 301
Min. Negotiated Rate $84.64
Max. Negotiated Rate $135.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $132.30
Rate for Payer: Altius Auto/Workers Compensation $129.60
Rate for Payer: Altius Commercial $129.60
Rate for Payer: Beech Street Commercial $132.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $110.84
Rate for Payer: Cash Price $94.50
Rate for Payer: ChoiceCare Network Commercial $130.95
Rate for Payer: Cigna of WY Commercial $132.30
Rate for Payer: Entrust Commercial $128.25
Rate for Payer: First Choice Health Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $128.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $89.10
Rate for Payer: HealthUtah PPO $135.00
Rate for Payer: Idaho Integrated Healthcare Commercial $130.95
Rate for Payer: Multiplan Medicare/VA $84.64
Rate for Payer: One Health Plan of WY PPO $132.30
Rate for Payer: PacificSource Commercial $121.50
Rate for Payer: PHCS PPO $132.30
Rate for Payer: Three Rivers PPO $101.25
Rate for Payer: TriWest Veterans Administration $89.10
Rate for Payer: United Healthcare Commercial $117.45
Rate for Payer: United Healthcare Medicare $89.10
Rate for Payer: WINHealth Partners Commercial $128.25
Rate for Payer: Wise Provider Network Commercial $128.25
Service Code HCPCS 99395
Hospital Charge Code 5109939501
Hospital Revenue Code 510
Min. Negotiated Rate $152.63
Max. Negotiated Rate $277.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $271.46
Rate for Payer: Aetna of WY Medicare $182.82
Rate for Payer: Altius Auto/Workers Compensation $265.92
Rate for Payer: Altius Commercial $265.92
Rate for Payer: Beech Street Commercial $271.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $227.42
Rate for Payer: Cash Price $193.90
Rate for Payer: ChoiceCare Network Commercial $268.69
Rate for Payer: Cigna of WY Commercial $271.46
Rate for Payer: Entrust Commercial $263.15
Rate for Payer: First Choice Health Commercial $263.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $263.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $160.66
Rate for Payer: HealthUtah PPO $277.00
Rate for Payer: Idaho Integrated Healthcare Commercial $268.69
Rate for Payer: Multiplan Medicare/VA $152.63
Rate for Payer: One Health Plan of WY PPO $271.46
Rate for Payer: PacificSource Commercial $249.30
Rate for Payer: PHCS PPO $271.46
Rate for Payer: Three Rivers PPO $207.75
Rate for Payer: TriWest Veterans Administration $160.66
Rate for Payer: United Healthcare Commercial $240.99
Rate for Payer: United Healthcare Medicare $160.66
Rate for Payer: WINHealth Partners Commercial $271.46
Rate for Payer: Wise Provider Network Commercial $263.15