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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
Service Code HCPCS 99397
Hospital Charge Code 5109939701
Hospital Revenue Code 510
Min. Negotiated Rate $218.82
Max. Negotiated Rate $349.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $342.02
Rate for Payer: Altius Auto/Workers Compensation $335.04
Rate for Payer: Altius Commercial $335.04
Rate for Payer: Beech Street Commercial $342.02
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $286.53
Rate for Payer: Cash Price $244.30
Rate for Payer: ChoiceCare Network Commercial $338.53
Rate for Payer: Cigna of WY Commercial $342.02
Rate for Payer: Entrust Commercial $331.55
Rate for Payer: First Choice Health Commercial $331.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $331.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $230.34
Rate for Payer: HealthUtah PPO $349.00
Rate for Payer: Idaho Integrated Healthcare Commercial $338.53
Rate for Payer: Multiplan Medicare/VA $218.82
Rate for Payer: One Health Plan of WY PPO $342.02
Rate for Payer: PacificSource Commercial $314.10
Rate for Payer: PHCS PPO $342.02
Rate for Payer: Three Rivers PPO $261.75
Rate for Payer: TriWest Veterans Administration $230.34
Rate for Payer: United Healthcare Commercial $303.63
Rate for Payer: United Healthcare Medicare $230.34
Rate for Payer: WINHealth Partners Commercial $331.55
Rate for Payer: Wise Provider Network Commercial $331.55
Service Code HCPCS 99397
Hospital Charge Code 5109939701
Hospital Revenue Code 510
Min. Negotiated Rate $192.30
Max. Negotiated Rate $349.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $342.02
Rate for Payer: Aetna of WY Medicare $230.34
Rate for Payer: Altius Auto/Workers Compensation $335.04
Rate for Payer: Altius Commercial $335.04
Rate for Payer: Beech Street Commercial $342.02
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $286.53
Rate for Payer: Cash Price $244.30
Rate for Payer: ChoiceCare Network Commercial $338.53
Rate for Payer: Cigna of WY Commercial $342.02
Rate for Payer: Entrust Commercial $331.55
Rate for Payer: First Choice Health Commercial $331.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $331.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $202.42
Rate for Payer: HealthUtah PPO $349.00
Rate for Payer: Idaho Integrated Healthcare Commercial $338.53
Rate for Payer: Multiplan Medicare/VA $192.30
Rate for Payer: One Health Plan of WY PPO $342.02
Rate for Payer: PacificSource Commercial $314.10
Rate for Payer: PHCS PPO $342.02
Rate for Payer: Three Rivers PPO $261.75
Rate for Payer: TriWest Veterans Administration $202.42
Rate for Payer: United Healthcare Commercial $303.63
Rate for Payer: United Healthcare Medicare $202.42
Rate for Payer: WINHealth Partners Commercial $342.02
Rate for Payer: Wise Provider Network Commercial $331.55
Service Code HCPCS 99385
Hospital Charge Code 5109938501
Hospital Revenue Code 510
Min. Negotiated Rate $201.89
Max. Negotiated Rate $322.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $315.56
Rate for Payer: Altius Auto/Workers Compensation $309.12
Rate for Payer: Altius Commercial $309.12
Rate for Payer: Beech Street Commercial $315.56
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $264.36
Rate for Payer: Cash Price $225.40
Rate for Payer: ChoiceCare Network Commercial $312.34
Rate for Payer: Cigna of WY Commercial $315.56
Rate for Payer: Entrust Commercial $305.90
Rate for Payer: First Choice Health Commercial $305.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $305.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $212.52
Rate for Payer: HealthUtah PPO $322.00
Rate for Payer: Idaho Integrated Healthcare Commercial $312.34
Rate for Payer: Multiplan Medicare/VA $201.89
Rate for Payer: One Health Plan of WY PPO $315.56
Rate for Payer: PacificSource Commercial $289.80
Rate for Payer: PHCS PPO $315.56
Rate for Payer: Three Rivers PPO $241.50
Rate for Payer: TriWest Veterans Administration $212.52
Rate for Payer: United Healthcare Commercial $280.14
Rate for Payer: United Healthcare Medicare $212.52
Rate for Payer: WINHealth Partners Commercial $305.90
Rate for Payer: Wise Provider Network Commercial $305.90
Service Code HCPCS 99385
Hospital Charge Code 5109938501
Hospital Revenue Code 510
Min. Negotiated Rate $177.42
Max. Negotiated Rate $322.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $315.56
Rate for Payer: Aetna of WY Medicare $212.52
Rate for Payer: Altius Auto/Workers Compensation $309.12
Rate for Payer: Altius Commercial $309.12
Rate for Payer: Beech Street Commercial $315.56
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $264.36
Rate for Payer: Cash Price $225.40
Rate for Payer: ChoiceCare Network Commercial $312.34
Rate for Payer: Cigna of WY Commercial $315.56
Rate for Payer: Entrust Commercial $305.90
Rate for Payer: First Choice Health Commercial $305.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $305.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $186.76
Rate for Payer: HealthUtah PPO $322.00
Rate for Payer: Idaho Integrated Healthcare Commercial $312.34
Rate for Payer: Multiplan Medicare/VA $177.42
Rate for Payer: One Health Plan of WY PPO $315.56
Rate for Payer: PacificSource Commercial $289.80
Rate for Payer: PHCS PPO $315.56
Rate for Payer: Three Rivers PPO $241.50
Rate for Payer: TriWest Veterans Administration $186.76
Rate for Payer: United Healthcare Commercial $280.14
Rate for Payer: United Healthcare Medicare $186.76
Rate for Payer: WINHealth Partners Commercial $315.56
Rate for Payer: Wise Provider Network Commercial $305.90
Service Code HCPCS 99386
Hospital Charge Code 5109938601
Hospital Revenue Code 510
Min. Negotiated Rate $197.81
Max. Negotiated Rate $359.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $351.82
Rate for Payer: Aetna of WY Medicare $236.94
Rate for Payer: Altius Auto/Workers Compensation $344.64
Rate for Payer: Altius Commercial $344.64
Rate for Payer: Beech Street Commercial $351.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $294.74
Rate for Payer: Cash Price $251.30
Rate for Payer: ChoiceCare Network Commercial $348.23
Rate for Payer: Cigna of WY Commercial $351.82
Rate for Payer: Entrust Commercial $341.05
Rate for Payer: First Choice Health Commercial $341.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $341.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $208.22
Rate for Payer: HealthUtah PPO $359.00
Rate for Payer: Idaho Integrated Healthcare Commercial $348.23
Rate for Payer: Multiplan Medicare/VA $197.81
Rate for Payer: One Health Plan of WY PPO $351.82
Rate for Payer: PacificSource Commercial $323.10
Rate for Payer: PHCS PPO $351.82
Rate for Payer: Three Rivers PPO $269.25
Rate for Payer: TriWest Veterans Administration $208.22
Rate for Payer: United Healthcare Commercial $312.33
Rate for Payer: United Healthcare Medicare $208.22
Rate for Payer: WINHealth Partners Commercial $351.82
Rate for Payer: Wise Provider Network Commercial $341.05
Service Code HCPCS 99386
Hospital Charge Code 5109938601
Hospital Revenue Code 510
Min. Negotiated Rate $225.09
Max. Negotiated Rate $359.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $351.82
Rate for Payer: Altius Auto/Workers Compensation $344.64
Rate for Payer: Altius Commercial $344.64
Rate for Payer: Beech Street Commercial $351.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $294.74
Rate for Payer: Cash Price $251.30
Rate for Payer: ChoiceCare Network Commercial $348.23
Rate for Payer: Cigna of WY Commercial $351.82
Rate for Payer: Entrust Commercial $341.05
Rate for Payer: First Choice Health Commercial $341.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $341.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $236.94
Rate for Payer: HealthUtah PPO $359.00
Rate for Payer: Idaho Integrated Healthcare Commercial $348.23
Rate for Payer: Multiplan Medicare/VA $225.09
Rate for Payer: One Health Plan of WY PPO $351.82
Rate for Payer: PacificSource Commercial $323.10
Rate for Payer: PHCS PPO $351.82
Rate for Payer: Three Rivers PPO $269.25
Rate for Payer: TriWest Veterans Administration $236.94
Rate for Payer: United Healthcare Commercial $312.33
Rate for Payer: United Healthcare Medicare $236.94
Rate for Payer: WINHealth Partners Commercial $341.05
Rate for Payer: Wise Provider Network Commercial $341.05
Service Code HCPCS 99387
Hospital Charge Code 5109938701
Hospital Revenue Code 510
Min. Negotiated Rate $215.44
Max. Negotiated Rate $391.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $383.18
Rate for Payer: Aetna of WY Medicare $258.06
Rate for Payer: Altius Auto/Workers Compensation $375.36
Rate for Payer: Altius Commercial $375.36
Rate for Payer: Beech Street Commercial $383.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $321.01
Rate for Payer: Cash Price $273.70
Rate for Payer: ChoiceCare Network Commercial $379.27
Rate for Payer: Cigna of WY Commercial $383.18
Rate for Payer: Entrust Commercial $371.45
Rate for Payer: First Choice Health Commercial $371.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $371.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $226.78
Rate for Payer: HealthUtah PPO $391.00
Rate for Payer: Idaho Integrated Healthcare Commercial $379.27
Rate for Payer: Multiplan Medicare/VA $215.44
Rate for Payer: One Health Plan of WY PPO $383.18
Rate for Payer: PacificSource Commercial $351.90
Rate for Payer: PHCS PPO $383.18
Rate for Payer: Three Rivers PPO $293.25
Rate for Payer: TriWest Veterans Administration $226.78
Rate for Payer: United Healthcare Commercial $340.17
Rate for Payer: United Healthcare Medicare $226.78
Rate for Payer: WINHealth Partners Commercial $383.18
Rate for Payer: Wise Provider Network Commercial $371.45
Service Code HCPCS 99387
Hospital Charge Code 5109938701
Hospital Revenue Code 510
Min. Negotiated Rate $245.16
Max. Negotiated Rate $391.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $383.18
Rate for Payer: Altius Auto/Workers Compensation $375.36
Rate for Payer: Altius Commercial $375.36
Rate for Payer: Beech Street Commercial $383.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $321.01
Rate for Payer: Cash Price $273.70
Rate for Payer: ChoiceCare Network Commercial $379.27
Rate for Payer: Cigna of WY Commercial $383.18
Rate for Payer: Entrust Commercial $371.45
Rate for Payer: First Choice Health Commercial $371.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $371.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $258.06
Rate for Payer: HealthUtah PPO $391.00
Rate for Payer: Idaho Integrated Healthcare Commercial $379.27
Rate for Payer: Multiplan Medicare/VA $245.16
Rate for Payer: One Health Plan of WY PPO $383.18
Rate for Payer: PacificSource Commercial $351.90
Rate for Payer: PHCS PPO $383.18
Rate for Payer: Three Rivers PPO $293.25
Rate for Payer: TriWest Veterans Administration $258.06
Rate for Payer: United Healthcare Commercial $340.17
Rate for Payer: United Healthcare Medicare $258.06
Rate for Payer: WINHealth Partners Commercial $371.45
Rate for Payer: Wise Provider Network Commercial $371.45
Hospital Charge Code 1100000004
Hospital Revenue Code 110
Min. Negotiated Rate $5,382.80
Max. Negotiated Rate $8,585.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $8,413.30
Rate for Payer: Aetna of WY Medicare $5,494.40
Rate for Payer: Altius Auto/Workers Compensation $8,241.60
Rate for Payer: Altius Commercial $8,241.60
Rate for Payer: Beech Street Commercial $8,413.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $7,048.28
Rate for Payer: Cash Price $6,009.50
Rate for Payer: ChoiceCare Network Commercial $8,327.45
Rate for Payer: Cigna of WY Commercial $8,413.30
Rate for Payer: Entrust Commercial $8,155.75
Rate for Payer: First Choice Health Commercial $8,155.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $8,155.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5,666.10
Rate for Payer: HealthUtah PPO $8,585.00
Rate for Payer: Idaho Integrated Healthcare Commercial $8,327.45
Rate for Payer: Multiplan Medicare/VA $5,382.80
Rate for Payer: One Health Plan of WY PPO $8,413.30
Rate for Payer: PacificSource Commercial $7,726.50
Rate for Payer: PHCS PPO $8,413.30
Rate for Payer: Three Rivers PPO $6,438.75
Rate for Payer: TriWest Veterans Administration $5,666.10
Rate for Payer: United Healthcare Commercial $7,468.95
Rate for Payer: United Healthcare Medicare $5,666.10
Rate for Payer: WINHealth Partners Commercial $8,155.75
Rate for Payer: Wise Provider Network Commercial $8,155.75
Hospital Charge Code 1100000002
Hospital Revenue Code 110
Min. Negotiated Rate $1,717.98
Max. Negotiated Rate $2,740.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,685.20
Rate for Payer: Aetna of WY Medicare $1,753.60
Rate for Payer: Altius Auto/Workers Compensation $2,630.40
Rate for Payer: Altius Commercial $2,630.40
Rate for Payer: Beech Street Commercial $2,685.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,249.54
Rate for Payer: Cash Price $1,918.00
Rate for Payer: ChoiceCare Network Commercial $2,657.80
Rate for Payer: Cigna of WY Commercial $2,685.20
Rate for Payer: Entrust Commercial $2,603.00
Rate for Payer: First Choice Health Commercial $2,603.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,603.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,808.40
Rate for Payer: HealthUtah PPO $2,740.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,657.80
Rate for Payer: Multiplan Medicare/VA $1,717.98
Rate for Payer: One Health Plan of WY PPO $2,685.20
Rate for Payer: PacificSource Commercial $2,466.00
Rate for Payer: PHCS PPO $2,685.20
Rate for Payer: Three Rivers PPO $2,055.00
Rate for Payer: TriWest Veterans Administration $1,808.40
Rate for Payer: United Healthcare Commercial $2,383.80
Rate for Payer: United Healthcare Medicare $1,808.40
Rate for Payer: WINHealth Partners Commercial $2,603.00
Rate for Payer: Wise Provider Network Commercial $2,603.00
Hospital Charge Code 1100000003
Hospital Revenue Code 110
Min. Negotiated Rate $4,771.47
Max. Negotiated Rate $7,610.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $7,457.80
Rate for Payer: Aetna of WY Medicare $4,870.40
Rate for Payer: Altius Auto/Workers Compensation $7,305.60
Rate for Payer: Altius Commercial $7,305.60
Rate for Payer: Beech Street Commercial $7,457.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6,247.81
Rate for Payer: Cash Price $5,327.00
Rate for Payer: ChoiceCare Network Commercial $7,381.70
Rate for Payer: Cigna of WY Commercial $7,457.80
Rate for Payer: Entrust Commercial $7,229.50
Rate for Payer: First Choice Health Commercial $7,229.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7,229.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5,022.60
Rate for Payer: HealthUtah PPO $7,610.00
Rate for Payer: Idaho Integrated Healthcare Commercial $7,381.70
Rate for Payer: Multiplan Medicare/VA $4,771.47
Rate for Payer: One Health Plan of WY PPO $7,457.80
Rate for Payer: PacificSource Commercial $6,849.00
Rate for Payer: PHCS PPO $7,457.80
Rate for Payer: Three Rivers PPO $5,707.50
Rate for Payer: TriWest Veterans Administration $5,022.60
Rate for Payer: United Healthcare Commercial $6,620.70
Rate for Payer: United Healthcare Medicare $5,022.60
Rate for Payer: WINHealth Partners Commercial $7,229.50
Rate for Payer: Wise Provider Network Commercial $7,229.50
Hospital Charge Code 1100000005
Hospital Revenue Code 110
Min. Negotiated Rate $3,009.60
Max. Negotiated Rate $4,800.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,704.00
Rate for Payer: Aetna of WY Medicare $3,072.00
Rate for Payer: Altius Auto/Workers Compensation $4,608.00
Rate for Payer: Altius Commercial $4,608.00
Rate for Payer: Beech Street Commercial $4,704.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3,940.80
Rate for Payer: Cash Price $3,360.00
Rate for Payer: ChoiceCare Network Commercial $4,656.00
Rate for Payer: Cigna of WY Commercial $4,704.00
Rate for Payer: Entrust Commercial $4,560.00
Rate for Payer: First Choice Health Commercial $4,560.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,560.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,168.00
Rate for Payer: HealthUtah PPO $4,800.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,656.00
Rate for Payer: Multiplan Medicare/VA $3,009.60
Rate for Payer: One Health Plan of WY PPO $4,704.00
Rate for Payer: PacificSource Commercial $4,320.00
Rate for Payer: PHCS PPO $4,704.00
Rate for Payer: Three Rivers PPO $3,600.00
Rate for Payer: TriWest Veterans Administration $3,168.00
Rate for Payer: United Healthcare Commercial $4,176.00
Rate for Payer: United Healthcare Medicare $3,168.00
Rate for Payer: WINHealth Partners Commercial $4,560.00
Rate for Payer: Wise Provider Network Commercial $4,560.00
Service Code HCPCS 76376
Hospital Charge Code 9727637601
Hospital Revenue Code 972
Min. Negotiated Rate $20.73
Max. Negotiated Rate $73.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $71.54
Rate for Payer: Aetna of WY Medicare $24.39
Rate for Payer: Beech Street Commercial $69.35
Rate for Payer: Cash Price $51.10
Rate for Payer: Cash Price $51.10
Rate for Payer: ChoiceCare Network Commercial $70.81
Rate for Payer: Cigna of WY Commercial $71.54
Rate for Payer: First Choice Health Commercial $65.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $69.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $24.39
Rate for Payer: HealthUtah PPO $73.00
Rate for Payer: Idaho Integrated Healthcare Commercial $70.81
Rate for Payer: Multiplan Medicare/VA $20.73
Rate for Payer: One Health Plan of WY PPO $71.54
Rate for Payer: PacificSource Commercial $65.70
Rate for Payer: PHCS PPO $69.35
Rate for Payer: Three Rivers PPO $54.75
Rate for Payer: TriWest Veterans Administration $24.39
Rate for Payer: United Healthcare Commercial $63.51
Rate for Payer: United Healthcare Medicare $24.39
Rate for Payer: WINHealth Partners Commercial $69.35
Service Code HCPCS 49083
Hospital Charge Code 9834908301
Hospital Revenue Code 983
Min. Negotiated Rate $85.38
Max. Negotiated Rate $1,389.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,361.22
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,205.40
Rate for Payer: Aetna of WY Medicare $100.45
Rate for Payer: Aetna of WY Medicare $100.45
Rate for Payer: Beech Street Commercial $1,168.50
Rate for Payer: Beech Street Commercial $1,319.55
Rate for Payer: Cash Price $861.00
Rate for Payer: Cash Price $861.00
Rate for Payer: Cash Price $972.30
Rate for Payer: Cash Price $972.30
Rate for Payer: ChoiceCare Network Commercial $1,347.33
Rate for Payer: ChoiceCare Network Commercial $1,193.10
Rate for Payer: Cigna of WY Commercial $1,205.40
Rate for Payer: Cigna of WY Commercial $1,361.22
Rate for Payer: First Choice Health Commercial $1,107.00
Rate for Payer: First Choice Health Commercial $1,250.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,319.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,168.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $100.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $100.45
Rate for Payer: HealthUtah PPO $1,389.00
Rate for Payer: HealthUtah PPO $1,230.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,347.33
Rate for Payer: Idaho Integrated Healthcare Commercial $1,193.10
Rate for Payer: Multiplan Medicare/VA $85.38
Rate for Payer: Multiplan Medicare/VA $85.38
Rate for Payer: One Health Plan of WY PPO $1,361.22
Rate for Payer: One Health Plan of WY PPO $1,205.40
Rate for Payer: PacificSource Commercial $1,107.00
Rate for Payer: PacificSource Commercial $1,250.10
Rate for Payer: PHCS PPO $1,319.55
Rate for Payer: PHCS PPO $1,168.50
Rate for Payer: Three Rivers PPO $1,041.75
Rate for Payer: Three Rivers PPO $922.50
Rate for Payer: TriWest Veterans Administration $100.45
Rate for Payer: TriWest Veterans Administration $100.45
Rate for Payer: United Healthcare Commercial $1,070.10
Rate for Payer: United Healthcare Commercial $1,208.43
Rate for Payer: United Healthcare Medicare $100.45
Rate for Payer: United Healthcare Medicare $100.45
Rate for Payer: WINHealth Partners Commercial $1,180.65
Rate for Payer: WINHealth Partners Commercial $1,045.50
Service Code HCPCS 49082
Hospital Charge Code 9834908201
Hospital Revenue Code 983
Min. Negotiated Rate $59.30
Max. Negotiated Rate $487.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $477.26
Rate for Payer: Aetna of WY Medicare $69.76
Rate for Payer: Beech Street Commercial $462.65
Rate for Payer: Cash Price $340.90
Rate for Payer: Cash Price $340.90
Rate for Payer: ChoiceCare Network Commercial $472.39
Rate for Payer: Cigna of WY Commercial $477.26
Rate for Payer: First Choice Health Commercial $438.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $462.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $69.76
Rate for Payer: HealthUtah PPO $487.00
Rate for Payer: Idaho Integrated Healthcare Commercial $472.39
Rate for Payer: Multiplan Medicare/VA $59.30
Rate for Payer: One Health Plan of WY PPO $477.26
Rate for Payer: PacificSource Commercial $438.30
Rate for Payer: PHCS PPO $462.65
Rate for Payer: Three Rivers PPO $365.25
Rate for Payer: TriWest Veterans Administration $69.76
Rate for Payer: United Healthcare Commercial $423.69
Rate for Payer: United Healthcare Medicare $69.76
Rate for Payer: WINHealth Partners Commercial $413.95
Service Code HCPCS 29884
Hospital Charge Code 9832988401
Hospital Revenue Code 983
Min. Negotiated Rate $512.86
Max. Negotiated Rate $3,192.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,128.16
Rate for Payer: Aetna of WY Medicare $603.37
Rate for Payer: Beech Street Commercial $3,032.40
Rate for Payer: Cash Price $2,234.40
Rate for Payer: Cash Price $2,234.40
Rate for Payer: ChoiceCare Network Commercial $3,096.24
Rate for Payer: Cigna of WY Commercial $3,128.16
Rate for Payer: First Choice Health Commercial $2,872.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,032.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $603.37
Rate for Payer: HealthUtah PPO $3,192.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,096.24
Rate for Payer: Multiplan Medicare/VA $512.86
Rate for Payer: One Health Plan of WY PPO $3,128.16
Rate for Payer: PacificSource Commercial $2,872.80
Rate for Payer: PHCS PPO $3,032.40
Rate for Payer: Three Rivers PPO $2,394.00
Rate for Payer: TriWest Veterans Administration $603.37
Rate for Payer: United Healthcare Commercial $2,777.04
Rate for Payer: United Healthcare Medicare $603.37
Rate for Payer: WINHealth Partners Commercial $2,713.20
Service Code HCPCS 10040
Hospital Charge Code 9831004001
Hospital Revenue Code 983
Min. Negotiated Rate $42.42
Max. Negotiated Rate $267.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $261.66
Rate for Payer: Aetna of WY Medicare $49.90
Rate for Payer: Beech Street Commercial $253.65
Rate for Payer: Cash Price $186.90
Rate for Payer: Cash Price $186.90
Rate for Payer: ChoiceCare Network Commercial $258.99
Rate for Payer: Cigna of WY Commercial $261.66
Rate for Payer: First Choice Health Commercial $240.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $253.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $49.90
Rate for Payer: HealthUtah PPO $267.00
Rate for Payer: Idaho Integrated Healthcare Commercial $258.99
Rate for Payer: Multiplan Medicare/VA $42.42
Rate for Payer: One Health Plan of WY PPO $261.66
Rate for Payer: PacificSource Commercial $240.30
Rate for Payer: PHCS PPO $253.65
Rate for Payer: Three Rivers PPO $200.25
Rate for Payer: TriWest Veterans Administration $49.90
Rate for Payer: United Healthcare Commercial $232.29
Rate for Payer: United Healthcare Medicare $49.90
Rate for Payer: WINHealth Partners Commercial $226.95
Service Code HCPCS 42831
Hospital Charge Code 9834283101
Hospital Revenue Code 983
Min. Negotiated Rate $193.32
Max. Negotiated Rate $1,156.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,132.88
Rate for Payer: Aetna of WY Medicare $227.43
Rate for Payer: Beech Street Commercial $1,098.20
Rate for Payer: Cash Price $809.20
Rate for Payer: Cash Price $809.20
Rate for Payer: ChoiceCare Network Commercial $1,121.32
Rate for Payer: Cigna of WY Commercial $1,132.88
Rate for Payer: First Choice Health Commercial $1,040.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,098.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $227.43
Rate for Payer: HealthUtah PPO $1,156.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,121.32
Rate for Payer: Multiplan Medicare/VA $193.32
Rate for Payer: One Health Plan of WY PPO $1,132.88
Rate for Payer: PacificSource Commercial $1,040.40
Rate for Payer: PHCS PPO $1,098.20
Rate for Payer: Three Rivers PPO $867.00
Rate for Payer: TriWest Veterans Administration $227.43
Rate for Payer: United Healthcare Commercial $1,005.72
Rate for Payer: United Healthcare Medicare $227.43
Rate for Payer: WINHealth Partners Commercial $982.60
Service Code HCPCS 42836
Hospital Charge Code 9834283601
Hospital Revenue Code 983
Min. Negotiated Rate $204.49
Max. Negotiated Rate $1,237.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,212.26
Rate for Payer: Aetna of WY Medicare $240.58
Rate for Payer: Beech Street Commercial $1,175.15
Rate for Payer: Cash Price $865.90
Rate for Payer: Cash Price $865.90
Rate for Payer: ChoiceCare Network Commercial $1,199.89
Rate for Payer: Cigna of WY Commercial $1,212.26
Rate for Payer: First Choice Health Commercial $1,113.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,175.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $240.58
Rate for Payer: HealthUtah PPO $1,237.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,199.89
Rate for Payer: Multiplan Medicare/VA $204.49
Rate for Payer: One Health Plan of WY PPO $1,212.26
Rate for Payer: PacificSource Commercial $1,113.30
Rate for Payer: PHCS PPO $1,175.15
Rate for Payer: Three Rivers PPO $927.75
Rate for Payer: TriWest Veterans Administration $240.58
Rate for Payer: United Healthcare Commercial $1,076.19
Rate for Payer: United Healthcare Medicare $240.58
Rate for Payer: WINHealth Partners Commercial $1,051.45
Service Code HCPCS 14021
Hospital Charge Code 9751402101
Hospital Revenue Code 975
Min. Negotiated Rate $582.12
Max. Negotiated Rate $3,542.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,471.16
Rate for Payer: Aetna of WY Medicare $684.85
Rate for Payer: Beech Street Commercial $3,364.90
Rate for Payer: Cash Price $2,479.40
Rate for Payer: Cash Price $2,479.40
Rate for Payer: ChoiceCare Network Commercial $3,435.74
Rate for Payer: Cigna of WY Commercial $3,471.16
Rate for Payer: First Choice Health Commercial $3,187.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,364.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $684.85
Rate for Payer: HealthUtah PPO $3,542.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,435.74
Rate for Payer: Multiplan Medicare/VA $582.12
Rate for Payer: One Health Plan of WY PPO $3,471.16
Rate for Payer: PacificSource Commercial $3,187.80
Rate for Payer: PHCS PPO $3,364.90
Rate for Payer: Three Rivers PPO $2,656.50
Rate for Payer: TriWest Veterans Administration $684.85
Rate for Payer: United Healthcare Commercial $3,081.54
Rate for Payer: United Healthcare Medicare $684.85
Rate for Payer: WINHealth Partners Commercial $3,010.70
Service Code HCPCS 14020
Hospital Charge Code 9831402001
Hospital Revenue Code 983
Min. Negotiated Rate $467.19
Max. Negotiated Rate $3,449.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,380.02
Rate for Payer: Aetna of WY Medicare $549.64
Rate for Payer: Beech Street Commercial $3,276.55
Rate for Payer: Cash Price $2,414.30
Rate for Payer: Cash Price $2,414.30
Rate for Payer: ChoiceCare Network Commercial $3,345.53
Rate for Payer: Cigna of WY Commercial $3,380.02
Rate for Payer: First Choice Health Commercial $3,104.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,276.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $549.64
Rate for Payer: HealthUtah PPO $3,449.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,345.53
Rate for Payer: Multiplan Medicare/VA $467.19
Rate for Payer: One Health Plan of WY PPO $3,380.02
Rate for Payer: PacificSource Commercial $3,104.10
Rate for Payer: PHCS PPO $3,276.55
Rate for Payer: Three Rivers PPO $2,586.75
Rate for Payer: TriWest Veterans Administration $549.64
Rate for Payer: United Healthcare Commercial $3,000.63
Rate for Payer: United Healthcare Medicare $549.64
Rate for Payer: WINHealth Partners Commercial $2,931.65
Service Code HCPCS 14040
Hospital Charge Code 9821404001
Hospital Revenue Code 982
Min. Negotiated Rate $513.17
Max. Negotiated Rate $3,113.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,050.74
Rate for Payer: Aetna of WY Medicare $603.73
Rate for Payer: Beech Street Commercial $2,957.35
Rate for Payer: Cash Price $2,179.10
Rate for Payer: Cash Price $2,179.10
Rate for Payer: ChoiceCare Network Commercial $3,019.61
Rate for Payer: Cigna of WY Commercial $3,050.74
Rate for Payer: First Choice Health Commercial $2,801.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,957.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $603.73
Rate for Payer: HealthUtah PPO $3,113.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,019.61
Rate for Payer: Multiplan Medicare/VA $513.17
Rate for Payer: One Health Plan of WY PPO $3,050.74
Rate for Payer: PacificSource Commercial $2,801.70
Rate for Payer: PHCS PPO $2,957.35
Rate for Payer: Three Rivers PPO $2,334.75
Rate for Payer: TriWest Veterans Administration $603.73
Rate for Payer: United Healthcare Commercial $2,708.31
Rate for Payer: United Healthcare Medicare $603.73
Rate for Payer: WINHealth Partners Commercial $2,646.05
Service Code HCPCS S2083
Hospital Charge Code 983S208301
Hospital Revenue Code 983
Min. Negotiated Rate $145.50
Max. Negotiated Rate $194.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $190.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $160.72
Rate for Payer: Beech Street Commercial $184.30
Rate for Payer: Beech Street Commercial $155.80
Rate for Payer: Cash Price $114.80
Rate for Payer: Cash Price $135.80
Rate for Payer: ChoiceCare Network Commercial $188.18
Rate for Payer: ChoiceCare Network Commercial $159.08
Rate for Payer: Cigna of WY Commercial $190.12
Rate for Payer: Cigna of WY Commercial $160.72
Rate for Payer: First Choice Health Commercial $174.60
Rate for Payer: First Choice Health Commercial $147.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $155.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $184.30
Rate for Payer: HealthUtah PPO $164.00
Rate for Payer: HealthUtah PPO $194.00
Rate for Payer: Idaho Integrated Healthcare Commercial $159.08
Rate for Payer: Idaho Integrated Healthcare Commercial $188.18
Rate for Payer: One Health Plan of WY PPO $160.72
Rate for Payer: One Health Plan of WY PPO $190.12
Rate for Payer: PacificSource Commercial $147.60
Rate for Payer: PacificSource Commercial $174.60
Rate for Payer: PHCS PPO $155.80
Rate for Payer: PHCS PPO $184.30
Rate for Payer: Three Rivers PPO $123.00
Rate for Payer: Three Rivers PPO $145.50
Rate for Payer: United Healthcare Commercial $168.78
Rate for Payer: United Healthcare Commercial $142.68
Rate for Payer: WINHealth Partners Commercial $155.80
Rate for Payer: WINHealth Partners Commercial $184.30
Service Code HCPCS S2083
Hospital Charge Code 981S208301
Hospital Revenue Code 981
Min. Negotiated Rate $140.25
Max. Negotiated Rate $187.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $183.26
Rate for Payer: Beech Street Commercial $177.65
Rate for Payer: Cash Price $130.90
Rate for Payer: ChoiceCare Network Commercial $181.39
Rate for Payer: Cigna of WY Commercial $183.26
Rate for Payer: First Choice Health Commercial $168.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $177.65
Rate for Payer: HealthUtah PPO $187.00
Rate for Payer: Idaho Integrated Healthcare Commercial $181.39
Rate for Payer: One Health Plan of WY PPO $183.26
Rate for Payer: PacificSource Commercial $168.30
Rate for Payer: PHCS PPO $177.65
Rate for Payer: Three Rivers PPO $140.25
Rate for Payer: United Healthcare Commercial $162.69
Rate for Payer: WINHealth Partners Commercial $177.65