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Service Code HCPCS Q3014
Hospital Charge Code 780Q301401
Hospital Revenue Code 780
Min. Negotiated Rate $38.57
Max. Negotiated Rate $70.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $68.60
Rate for Payer: Aetna of WY Medicare $46.20
Rate for Payer: Altius Auto/Workers Compensation $67.20
Rate for Payer: Altius Commercial $67.20
Rate for Payer: Beech Street Commercial $68.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $57.47
Rate for Payer: Cash Price $49.00
Rate for Payer: ChoiceCare Network Commercial $67.90
Rate for Payer: Cigna of WY Commercial $68.60
Rate for Payer: Entrust Commercial $66.50
Rate for Payer: First Choice Health Commercial $66.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $66.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $40.60
Rate for Payer: HealthUtah PPO $70.00
Rate for Payer: Idaho Integrated Healthcare Commercial $67.90
Rate for Payer: Multiplan Medicare/VA $38.57
Rate for Payer: One Health Plan of WY PPO $68.60
Rate for Payer: PacificSource Commercial $63.00
Rate for Payer: PHCS PPO $68.60
Rate for Payer: Three Rivers PPO $52.50
Rate for Payer: TriWest Veterans Administration $40.60
Rate for Payer: United Healthcare Commercial $60.90
Rate for Payer: United Healthcare Medicare $40.60
Rate for Payer: WINHealth Partners Commercial $68.60
Rate for Payer: Wise Provider Network Commercial $66.50
Service Code HCPCS Q3014
Hospital Charge Code 780Q301401
Hospital Revenue Code 780
Min. Negotiated Rate $43.89
Max. Negotiated Rate $70.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $68.60
Rate for Payer: Altius Auto/Workers Compensation $67.20
Rate for Payer: Altius Commercial $67.20
Rate for Payer: Beech Street Commercial $68.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $57.47
Rate for Payer: Cash Price $49.00
Rate for Payer: ChoiceCare Network Commercial $67.90
Rate for Payer: Cigna of WY Commercial $68.60
Rate for Payer: Entrust Commercial $66.50
Rate for Payer: First Choice Health Commercial $66.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $66.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $46.20
Rate for Payer: HealthUtah PPO $70.00
Rate for Payer: Idaho Integrated Healthcare Commercial $67.90
Rate for Payer: Multiplan Medicare/VA $43.89
Rate for Payer: One Health Plan of WY PPO $68.60
Rate for Payer: PacificSource Commercial $63.00
Rate for Payer: PHCS PPO $68.60
Rate for Payer: Three Rivers PPO $52.50
Rate for Payer: TriWest Veterans Administration $46.20
Rate for Payer: United Healthcare Commercial $60.90
Rate for Payer: United Healthcare Medicare $46.20
Rate for Payer: WINHealth Partners Commercial $66.50
Rate for Payer: Wise Provider Network Commercial $66.50
Service Code HCPCS A4595
Hospital Charge Code 420A459501
Hospital Revenue Code 420
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS A4595
Hospital Charge Code 420A459501
Hospital Revenue Code 420
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS A4595
Hospital Charge Code 430A459501
Hospital Revenue Code 430
Min. Negotiated Rate $55.10
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Aetna of WY Medicare $66.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $55.10
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $58.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $58.00
Rate for Payer: WINHealth Partners Commercial $98.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS A4595
Hospital Charge Code 430A459501
Hospital Revenue Code 430
Min. Negotiated Rate $62.70
Max. Negotiated Rate $100.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $98.00
Rate for Payer: Altius Auto/Workers Compensation $96.00
Rate for Payer: Altius Commercial $96.00
Rate for Payer: Beech Street Commercial $98.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $82.10
Rate for Payer: Cash Price $70.00
Rate for Payer: ChoiceCare Network Commercial $97.00
Rate for Payer: Cigna of WY Commercial $98.00
Rate for Payer: Entrust Commercial $95.00
Rate for Payer: First Choice Health Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $95.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.00
Rate for Payer: HealthUtah PPO $100.00
Rate for Payer: Idaho Integrated Healthcare Commercial $97.00
Rate for Payer: Multiplan Medicare/VA $62.70
Rate for Payer: One Health Plan of WY PPO $98.00
Rate for Payer: PacificSource Commercial $90.00
Rate for Payer: PHCS PPO $98.00
Rate for Payer: Three Rivers PPO $75.00
Rate for Payer: TriWest Veterans Administration $66.00
Rate for Payer: United Healthcare Commercial $87.00
Rate for Payer: United Healthcare Medicare $66.00
Rate for Payer: WINHealth Partners Commercial $95.00
Rate for Payer: Wise Provider Network Commercial $95.00
Service Code HCPCS 86774
Hospital Charge Code 3028677401
Hospital Revenue Code 302
Min. Negotiated Rate $81.51
Max. Negotiated Rate $130.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $127.40
Rate for Payer: Altius Auto/Workers Compensation $124.80
Rate for Payer: Altius Commercial $124.80
Rate for Payer: Beech Street Commercial $127.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $106.73
Rate for Payer: Cash Price $91.00
Rate for Payer: ChoiceCare Network Commercial $126.10
Rate for Payer: Cigna of WY Commercial $127.40
Rate for Payer: Entrust Commercial $123.50
Rate for Payer: First Choice Health Commercial $123.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $123.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $85.80
Rate for Payer: HealthUtah PPO $130.00
Rate for Payer: Idaho Integrated Healthcare Commercial $126.10
Rate for Payer: Multiplan Medicare/VA $81.51
Rate for Payer: One Health Plan of WY PPO $127.40
Rate for Payer: PacificSource Commercial $117.00
Rate for Payer: PHCS PPO $127.40
Rate for Payer: Three Rivers PPO $97.50
Rate for Payer: TriWest Veterans Administration $85.80
Rate for Payer: United Healthcare Commercial $113.10
Rate for Payer: United Healthcare Medicare $85.80
Rate for Payer: WINHealth Partners Commercial $123.50
Rate for Payer: Wise Provider Network Commercial $123.50
Service Code HCPCS 86774
Hospital Charge Code 3028677401
Hospital Revenue Code 302
Min. Negotiated Rate $71.63
Max. Negotiated Rate $130.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $127.40
Rate for Payer: Aetna of WY Medicare $85.80
Rate for Payer: Altius Auto/Workers Compensation $124.80
Rate for Payer: Altius Commercial $124.80
Rate for Payer: Beech Street Commercial $127.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $106.73
Rate for Payer: Cash Price $91.00
Rate for Payer: ChoiceCare Network Commercial $126.10
Rate for Payer: Cigna of WY Commercial $127.40
Rate for Payer: Entrust Commercial $123.50
Rate for Payer: First Choice Health Commercial $123.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $123.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $75.40
Rate for Payer: HealthUtah PPO $130.00
Rate for Payer: Idaho Integrated Healthcare Commercial $126.10
Rate for Payer: Multiplan Medicare/VA $71.63
Rate for Payer: One Health Plan of WY PPO $127.40
Rate for Payer: PacificSource Commercial $117.00
Rate for Payer: PHCS PPO $127.40
Rate for Payer: Three Rivers PPO $97.50
Rate for Payer: TriWest Veterans Administration $75.40
Rate for Payer: United Healthcare Commercial $113.10
Rate for Payer: United Healthcare Medicare $75.40
Rate for Payer: WINHealth Partners Commercial $127.40
Rate for Payer: Wise Provider Network Commercial $123.50
Service Code HCPCS 96375
Hospital Charge Code 5109637501
Hospital Revenue Code 510
Min. Negotiated Rate $222.58
Max. Negotiated Rate $355.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $347.90
Rate for Payer: Altius Auto/Workers Compensation $340.80
Rate for Payer: Altius Commercial $340.80
Rate for Payer: Beech Street Commercial $347.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $291.46
Rate for Payer: Cash Price $248.50
Rate for Payer: ChoiceCare Network Commercial $344.35
Rate for Payer: Cigna of WY Commercial $347.90
Rate for Payer: Entrust Commercial $337.25
Rate for Payer: First Choice Health Commercial $337.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $337.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $234.30
Rate for Payer: HealthUtah PPO $355.00
Rate for Payer: Idaho Integrated Healthcare Commercial $344.35
Rate for Payer: Multiplan Medicare/VA $222.58
Rate for Payer: One Health Plan of WY PPO $347.90
Rate for Payer: PacificSource Commercial $319.50
Rate for Payer: PHCS PPO $347.90
Rate for Payer: Three Rivers PPO $266.25
Rate for Payer: TriWest Veterans Administration $234.30
Rate for Payer: United Healthcare Commercial $308.85
Rate for Payer: United Healthcare Medicare $234.30
Rate for Payer: WINHealth Partners Commercial $337.25
Rate for Payer: Wise Provider Network Commercial $337.25
Service Code HCPCS 96375
Hospital Charge Code 5109637501
Hospital Revenue Code 510
Min. Negotiated Rate $195.60
Max. Negotiated Rate $355.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $347.90
Rate for Payer: Aetna of WY Medicare $234.30
Rate for Payer: Altius Auto/Workers Compensation $340.80
Rate for Payer: Altius Commercial $340.80
Rate for Payer: Beech Street Commercial $347.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $291.46
Rate for Payer: Cash Price $248.50
Rate for Payer: ChoiceCare Network Commercial $344.35
Rate for Payer: Cigna of WY Commercial $347.90
Rate for Payer: Entrust Commercial $337.25
Rate for Payer: First Choice Health Commercial $337.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $337.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $205.90
Rate for Payer: HealthUtah PPO $355.00
Rate for Payer: Idaho Integrated Healthcare Commercial $344.35
Rate for Payer: Multiplan Medicare/VA $195.60
Rate for Payer: One Health Plan of WY PPO $347.90
Rate for Payer: PacificSource Commercial $319.50
Rate for Payer: PHCS PPO $347.90
Rate for Payer: Three Rivers PPO $266.25
Rate for Payer: TriWest Veterans Administration $205.90
Rate for Payer: United Healthcare Commercial $308.85
Rate for Payer: United Healthcare Medicare $205.90
Rate for Payer: WINHealth Partners Commercial $347.90
Rate for Payer: Wise Provider Network Commercial $337.25
Service Code HCPCS 84433
Hospital Charge Code 3018443301
Hospital Revenue Code 301
Min. Negotiated Rate $12.12
Max. Negotiated Rate $22.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $21.56
Rate for Payer: Aetna of WY Medicare $14.52
Rate for Payer: Altius Auto/Workers Compensation $21.12
Rate for Payer: Altius Commercial $21.12
Rate for Payer: Beech Street Commercial $21.56
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $18.06
Rate for Payer: Cash Price $15.40
Rate for Payer: ChoiceCare Network Commercial $21.34
Rate for Payer: Cigna of WY Commercial $21.56
Rate for Payer: Entrust Commercial $20.90
Rate for Payer: First Choice Health Commercial $20.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $20.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $12.76
Rate for Payer: HealthUtah PPO $22.00
Rate for Payer: Idaho Integrated Healthcare Commercial $21.34
Rate for Payer: Multiplan Medicare/VA $12.12
Rate for Payer: One Health Plan of WY PPO $21.56
Rate for Payer: PacificSource Commercial $19.80
Rate for Payer: PHCS PPO $21.56
Rate for Payer: Three Rivers PPO $16.50
Rate for Payer: TriWest Veterans Administration $12.76
Rate for Payer: United Healthcare Commercial $19.14
Rate for Payer: United Healthcare Medicare $12.76
Rate for Payer: WINHealth Partners Commercial $21.56
Rate for Payer: Wise Provider Network Commercial $20.90
Service Code HCPCS 84433
Hospital Charge Code 3018443301
Hospital Revenue Code 301
Min. Negotiated Rate $13.79
Max. Negotiated Rate $22.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $21.56
Rate for Payer: Altius Auto/Workers Compensation $21.12
Rate for Payer: Altius Commercial $21.12
Rate for Payer: Beech Street Commercial $21.56
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $18.06
Rate for Payer: Cash Price $15.40
Rate for Payer: ChoiceCare Network Commercial $21.34
Rate for Payer: Cigna of WY Commercial $21.56
Rate for Payer: Entrust Commercial $20.90
Rate for Payer: First Choice Health Commercial $20.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $20.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $14.52
Rate for Payer: HealthUtah PPO $22.00
Rate for Payer: Idaho Integrated Healthcare Commercial $21.34
Rate for Payer: Multiplan Medicare/VA $13.79
Rate for Payer: One Health Plan of WY PPO $21.56
Rate for Payer: PacificSource Commercial $19.80
Rate for Payer: PHCS PPO $21.56
Rate for Payer: Three Rivers PPO $16.50
Rate for Payer: TriWest Veterans Administration $14.52
Rate for Payer: United Healthcare Commercial $19.14
Rate for Payer: United Healthcare Medicare $14.52
Rate for Payer: WINHealth Partners Commercial $20.90
Rate for Payer: Wise Provider Network Commercial $20.90
Service Code HCPCS 32555
Hospital Charge Code 4023255501
Hospital Revenue Code 402
Min. Negotiated Rate $2,821.12
Max. Negotiated Rate $5,120.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,017.60
Rate for Payer: Aetna of WY Medicare $3,379.20
Rate for Payer: Altius Auto/Workers Compensation $4,915.20
Rate for Payer: Altius Commercial $4,915.20
Rate for Payer: Beech Street Commercial $5,017.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,203.52
Rate for Payer: Cash Price $3,584.00
Rate for Payer: ChoiceCare Network Commercial $4,966.40
Rate for Payer: Cigna of WY Commercial $5,017.60
Rate for Payer: Entrust Commercial $4,864.00
Rate for Payer: First Choice Health Commercial $4,864.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,864.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,969.60
Rate for Payer: HealthUtah PPO $5,120.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,966.40
Rate for Payer: Multiplan Medicare/VA $2,821.12
Rate for Payer: One Health Plan of WY PPO $5,017.60
Rate for Payer: PacificSource Commercial $4,608.00
Rate for Payer: PHCS PPO $5,017.60
Rate for Payer: Three Rivers PPO $3,840.00
Rate for Payer: TriWest Veterans Administration $2,969.60
Rate for Payer: United Healthcare Commercial $4,454.40
Rate for Payer: United Healthcare Medicare $2,969.60
Rate for Payer: WINHealth Partners Commercial $5,017.60
Rate for Payer: Wise Provider Network Commercial $4,864.00
Service Code HCPCS 32555
Hospital Charge Code 4023255501
Hospital Revenue Code 402
Min. Negotiated Rate $3,210.24
Max. Negotiated Rate $5,120.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,017.60
Rate for Payer: Altius Auto/Workers Compensation $4,915.20
Rate for Payer: Altius Commercial $4,915.20
Rate for Payer: Beech Street Commercial $5,017.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,203.52
Rate for Payer: Cash Price $3,584.00
Rate for Payer: ChoiceCare Network Commercial $4,966.40
Rate for Payer: Cigna of WY Commercial $5,017.60
Rate for Payer: Entrust Commercial $4,864.00
Rate for Payer: First Choice Health Commercial $4,864.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,864.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,379.20
Rate for Payer: HealthUtah PPO $5,120.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,966.40
Rate for Payer: Multiplan Medicare/VA $3,210.24
Rate for Payer: One Health Plan of WY PPO $5,017.60
Rate for Payer: PacificSource Commercial $4,608.00
Rate for Payer: PHCS PPO $5,017.60
Rate for Payer: Three Rivers PPO $3,840.00
Rate for Payer: TriWest Veterans Administration $3,379.20
Rate for Payer: United Healthcare Commercial $4,454.40
Rate for Payer: United Healthcare Medicare $3,379.20
Rate for Payer: WINHealth Partners Commercial $4,864.00
Rate for Payer: Wise Provider Network Commercial $4,864.00
Service Code HCPCS 32555
Hospital Charge Code 7613255501
Hospital Revenue Code 761
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 32555
Hospital Charge Code 3503255501
Hospital Revenue Code 350
Min. Negotiated Rate $2,821.12
Max. Negotiated Rate $5,120.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,017.60
Rate for Payer: Aetna of WY Medicare $3,379.20
Rate for Payer: Altius Auto/Workers Compensation $4,915.20
Rate for Payer: Altius Commercial $4,915.20
Rate for Payer: Beech Street Commercial $5,017.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,203.52
Rate for Payer: Cash Price $3,584.00
Rate for Payer: ChoiceCare Network Commercial $4,966.40
Rate for Payer: Cigna of WY Commercial $5,017.60
Rate for Payer: Entrust Commercial $4,864.00
Rate for Payer: First Choice Health Commercial $4,864.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,864.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,969.60
Rate for Payer: HealthUtah PPO $5,120.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,966.40
Rate for Payer: Multiplan Medicare/VA $2,821.12
Rate for Payer: One Health Plan of WY PPO $5,017.60
Rate for Payer: PacificSource Commercial $4,608.00
Rate for Payer: PHCS PPO $5,017.60
Rate for Payer: Three Rivers PPO $3,840.00
Rate for Payer: TriWest Veterans Administration $2,969.60
Rate for Payer: United Healthcare Commercial $4,454.40
Rate for Payer: United Healthcare Medicare $2,969.60
Rate for Payer: WINHealth Partners Commercial $5,017.60
Rate for Payer: Wise Provider Network Commercial $4,864.00
Service Code HCPCS 32555
Hospital Charge Code 3503255501
Hospital Revenue Code 350
Min. Negotiated Rate $3,210.24
Max. Negotiated Rate $5,120.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,017.60
Rate for Payer: Altius Auto/Workers Compensation $4,915.20
Rate for Payer: Altius Commercial $4,915.20
Rate for Payer: Beech Street Commercial $5,017.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,203.52
Rate for Payer: Cash Price $3,584.00
Rate for Payer: ChoiceCare Network Commercial $4,966.40
Rate for Payer: Cigna of WY Commercial $5,017.60
Rate for Payer: Entrust Commercial $4,864.00
Rate for Payer: First Choice Health Commercial $4,864.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,864.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,379.20
Rate for Payer: HealthUtah PPO $5,120.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,966.40
Rate for Payer: Multiplan Medicare/VA $3,210.24
Rate for Payer: One Health Plan of WY PPO $5,017.60
Rate for Payer: PacificSource Commercial $4,608.00
Rate for Payer: PHCS PPO $5,017.60
Rate for Payer: Three Rivers PPO $3,840.00
Rate for Payer: TriWest Veterans Administration $3,379.20
Rate for Payer: United Healthcare Commercial $4,454.40
Rate for Payer: United Healthcare Medicare $3,379.20
Rate for Payer: WINHealth Partners Commercial $4,864.00
Rate for Payer: Wise Provider Network Commercial $4,864.00
Service Code HCPCS 32555
Hospital Charge Code 7613255501
Hospital Revenue Code 761
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 32554
Hospital Charge Code 7613255401
Hospital Revenue Code 761
Min. Negotiated Rate $294.23
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Aetna of WY Medicare $352.44
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $309.72
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $294.23
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $309.72
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $309.72
Rate for Payer: WINHealth Partners Commercial $523.32
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 32554
Hospital Charge Code 7613255401
Hospital Revenue Code 761
Min. Negotiated Rate $334.82
Max. Negotiated Rate $534.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $523.32
Rate for Payer: Altius Auto/Workers Compensation $512.64
Rate for Payer: Altius Commercial $512.64
Rate for Payer: Beech Street Commercial $523.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $438.41
Rate for Payer: Cash Price $373.80
Rate for Payer: ChoiceCare Network Commercial $517.98
Rate for Payer: Cigna of WY Commercial $523.32
Rate for Payer: Entrust Commercial $507.30
Rate for Payer: First Choice Health Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $507.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $352.44
Rate for Payer: HealthUtah PPO $534.00
Rate for Payer: Idaho Integrated Healthcare Commercial $517.98
Rate for Payer: Multiplan Medicare/VA $334.82
Rate for Payer: One Health Plan of WY PPO $523.32
Rate for Payer: PacificSource Commercial $480.60
Rate for Payer: PHCS PPO $523.32
Rate for Payer: Three Rivers PPO $400.50
Rate for Payer: TriWest Veterans Administration $352.44
Rate for Payer: United Healthcare Commercial $464.58
Rate for Payer: United Healthcare Medicare $352.44
Rate for Payer: WINHealth Partners Commercial $507.30
Rate for Payer: Wise Provider Network Commercial $507.30
Service Code HCPCS 32554 50
Hospital Charge Code 5103255401
Hospital Revenue Code 510
Min. Negotiated Rate $116.62
Max. Negotiated Rate $186.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $182.28
Rate for Payer: Altius Auto/Workers Compensation $178.56
Rate for Payer: Altius Commercial $178.56
Rate for Payer: Beech Street Commercial $182.28
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $152.71
Rate for Payer: Cash Price $130.20
Rate for Payer: ChoiceCare Network Commercial $180.42
Rate for Payer: Cigna of WY Commercial $182.28
Rate for Payer: Entrust Commercial $176.70
Rate for Payer: First Choice Health Commercial $176.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $176.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $122.76
Rate for Payer: HealthUtah PPO $186.00
Rate for Payer: Idaho Integrated Healthcare Commercial $180.42
Rate for Payer: Multiplan Medicare/VA $116.62
Rate for Payer: One Health Plan of WY PPO $182.28
Rate for Payer: PacificSource Commercial $167.40
Rate for Payer: PHCS PPO $182.28
Rate for Payer: Three Rivers PPO $139.50
Rate for Payer: TriWest Veterans Administration $122.76
Rate for Payer: United Healthcare Commercial $161.82
Rate for Payer: United Healthcare Medicare $122.76
Rate for Payer: WINHealth Partners Commercial $176.70
Rate for Payer: Wise Provider Network Commercial $176.70
Service Code HCPCS 32554 50
Hospital Charge Code 5103255401
Hospital Revenue Code 510
Min. Negotiated Rate $102.49
Max. Negotiated Rate $186.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $182.28
Rate for Payer: Aetna of WY Medicare $122.76
Rate for Payer: Altius Auto/Workers Compensation $178.56
Rate for Payer: Altius Commercial $178.56
Rate for Payer: Beech Street Commercial $182.28
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $152.71
Rate for Payer: Cash Price $130.20
Rate for Payer: ChoiceCare Network Commercial $180.42
Rate for Payer: Cigna of WY Commercial $182.28
Rate for Payer: Entrust Commercial $176.70
Rate for Payer: First Choice Health Commercial $176.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $176.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $107.88
Rate for Payer: HealthUtah PPO $186.00
Rate for Payer: Idaho Integrated Healthcare Commercial $180.42
Rate for Payer: Multiplan Medicare/VA $102.49
Rate for Payer: One Health Plan of WY PPO $182.28
Rate for Payer: PacificSource Commercial $167.40
Rate for Payer: PHCS PPO $182.28
Rate for Payer: Three Rivers PPO $139.50
Rate for Payer: TriWest Veterans Administration $107.88
Rate for Payer: United Healthcare Commercial $161.82
Rate for Payer: United Healthcare Medicare $107.88
Rate for Payer: WINHealth Partners Commercial $182.28
Rate for Payer: Wise Provider Network Commercial $176.70
Service Code HCPCS 32554
Hospital Charge Code 5103255401
Hospital Revenue Code 510
Min. Negotiated Rate $51.24
Max. Negotiated Rate $93.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $91.14
Rate for Payer: Aetna of WY Medicare $61.38
Rate for Payer: Altius Auto/Workers Compensation $89.28
Rate for Payer: Altius Commercial $89.28
Rate for Payer: Beech Street Commercial $91.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $76.35
Rate for Payer: Cash Price $65.10
Rate for Payer: ChoiceCare Network Commercial $90.21
Rate for Payer: Cigna of WY Commercial $91.14
Rate for Payer: Entrust Commercial $88.35
Rate for Payer: First Choice Health Commercial $88.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $88.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $53.94
Rate for Payer: HealthUtah PPO $93.00
Rate for Payer: Idaho Integrated Healthcare Commercial $90.21
Rate for Payer: Multiplan Medicare/VA $51.24
Rate for Payer: One Health Plan of WY PPO $91.14
Rate for Payer: PacificSource Commercial $83.70
Rate for Payer: PHCS PPO $91.14
Rate for Payer: Three Rivers PPO $69.75
Rate for Payer: TriWest Veterans Administration $53.94
Rate for Payer: United Healthcare Commercial $80.91
Rate for Payer: United Healthcare Medicare $53.94
Rate for Payer: WINHealth Partners Commercial $91.14
Rate for Payer: Wise Provider Network Commercial $88.35
Service Code HCPCS 32554
Hospital Charge Code 5103255401
Hospital Revenue Code 510
Min. Negotiated Rate $58.31
Max. Negotiated Rate $93.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $91.14
Rate for Payer: Altius Auto/Workers Compensation $89.28
Rate for Payer: Altius Commercial $89.28
Rate for Payer: Beech Street Commercial $91.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $76.35
Rate for Payer: Cash Price $65.10
Rate for Payer: ChoiceCare Network Commercial $90.21
Rate for Payer: Cigna of WY Commercial $91.14
Rate for Payer: Entrust Commercial $88.35
Rate for Payer: First Choice Health Commercial $88.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $88.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $61.38
Rate for Payer: HealthUtah PPO $93.00
Rate for Payer: Idaho Integrated Healthcare Commercial $90.21
Rate for Payer: Multiplan Medicare/VA $58.31
Rate for Payer: One Health Plan of WY PPO $91.14
Rate for Payer: PacificSource Commercial $83.70
Rate for Payer: PHCS PPO $91.14
Rate for Payer: Three Rivers PPO $69.75
Rate for Payer: TriWest Veterans Administration $61.38
Rate for Payer: United Healthcare Commercial $80.91
Rate for Payer: United Healthcare Medicare $61.38
Rate for Payer: WINHealth Partners Commercial $88.35
Rate for Payer: Wise Provider Network Commercial $88.35
Service Code HCPCS 85730
Hospital Charge Code 3058573001
Hospital Revenue Code 305
Min. Negotiated Rate $112.86
Max. Negotiated Rate $180.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $176.40
Rate for Payer: Altius Auto/Workers Compensation $172.80
Rate for Payer: Altius Commercial $172.80
Rate for Payer: Beech Street Commercial $176.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $147.78
Rate for Payer: Cash Price $126.00
Rate for Payer: ChoiceCare Network Commercial $174.60
Rate for Payer: Cigna of WY Commercial $176.40
Rate for Payer: Entrust Commercial $171.00
Rate for Payer: First Choice Health Commercial $171.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $171.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $118.80
Rate for Payer: HealthUtah PPO $180.00
Rate for Payer: Idaho Integrated Healthcare Commercial $174.60
Rate for Payer: Multiplan Medicare/VA $112.86
Rate for Payer: One Health Plan of WY PPO $176.40
Rate for Payer: PacificSource Commercial $162.00
Rate for Payer: PHCS PPO $176.40
Rate for Payer: Three Rivers PPO $135.00
Rate for Payer: TriWest Veterans Administration $118.80
Rate for Payer: United Healthcare Commercial $156.60
Rate for Payer: United Healthcare Medicare $118.80
Rate for Payer: WINHealth Partners Commercial $171.00
Rate for Payer: Wise Provider Network Commercial $171.00