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Service Code HCPCS 00472
Hospital Charge Code 9640047201
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00908
Hospital Charge Code 9640090801
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00404
Hospital Charge Code 9640040401
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00904
Hospital Charge Code 9640090401
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00402
Hospital Charge Code 9640040201
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00100
Hospital Charge Code 9640010001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01714
Hospital Charge Code 9640171401
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01924
Hospital Charge Code 9640192401
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00620
Hospital Charge Code 9640062001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00539
Hospital Charge Code 9640053901
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00914
Hospital Charge Code 9640091401
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01232
Hospital Charge Code 9640123201
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00700
Hospital Charge Code 9640070001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00732
Hospital Charge Code 9640073201
Hospital Revenue Code 964
Min. Negotiated Rate $159.00
Max. Negotiated Rate $212.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $207.76
Rate for Payer: Beech Street Commercial $201.40
Rate for Payer: Cash Price $148.40
Rate for Payer: ChoiceCare Network Commercial $205.64
Rate for Payer: Cigna of WY Commercial $207.76
Rate for Payer: First Choice Health Commercial $190.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $201.40
Rate for Payer: HealthUtah PPO $212.00
Rate for Payer: Idaho Integrated Healthcare Commercial $205.64
Rate for Payer: One Health Plan of WY PPO $207.76
Rate for Payer: PacificSource Commercial $190.80
Rate for Payer: PHCS PPO $201.40
Rate for Payer: Three Rivers PPO $159.00
Rate for Payer: United Healthcare Commercial $184.44
Rate for Payer: WINHealth Partners Commercial $201.40
Service Code HCPCS 00731
Hospital Charge Code 9640073101
Hospital Revenue Code 964
Min. Negotiated Rate $159.00
Max. Negotiated Rate $212.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $207.76
Rate for Payer: Beech Street Commercial $201.40
Rate for Payer: Cash Price $148.40
Rate for Payer: ChoiceCare Network Commercial $205.64
Rate for Payer: Cigna of WY Commercial $207.76
Rate for Payer: First Choice Health Commercial $190.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $201.40
Rate for Payer: HealthUtah PPO $212.00
Rate for Payer: Idaho Integrated Healthcare Commercial $205.64
Rate for Payer: One Health Plan of WY PPO $207.76
Rate for Payer: PacificSource Commercial $190.80
Rate for Payer: PHCS PPO $201.40
Rate for Payer: Three Rivers PPO $159.00
Rate for Payer: United Healthcare Commercial $184.44
Rate for Payer: WINHealth Partners Commercial $201.40
Service Code HCPCS 00730
Hospital Charge Code 9640073001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01960
Hospital Charge Code 9640196001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00944
Hospital Charge Code 9640094401
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 00940
Hospital Charge Code 9640094001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01844
Hospital Charge Code 9640184401
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01850
Hospital Charge Code 9640185001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01430
Hospital Charge Code 9640143001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01520
Hospital Charge Code 9640152001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01670
Hospital Charge Code 9640167001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30
Service Code HCPCS 01780
Hospital Charge Code 9640178001
Hospital Revenue Code 964
Min. Negotiated Rate $235.50
Max. Negotiated Rate $314.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $307.72
Rate for Payer: Beech Street Commercial $298.30
Rate for Payer: Cash Price $219.80
Rate for Payer: ChoiceCare Network Commercial $304.58
Rate for Payer: Cigna of WY Commercial $307.72
Rate for Payer: First Choice Health Commercial $282.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $298.30
Rate for Payer: HealthUtah PPO $314.00
Rate for Payer: Idaho Integrated Healthcare Commercial $304.58
Rate for Payer: One Health Plan of WY PPO $307.72
Rate for Payer: PacificSource Commercial $282.60
Rate for Payer: PHCS PPO $298.30
Rate for Payer: Three Rivers PPO $235.50
Rate for Payer: United Healthcare Commercial $273.18
Rate for Payer: WINHealth Partners Commercial $298.30