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Service Code HCPCS 76604
Hospital Charge Code 4027660402
Hospital Revenue Code 402
Min. Negotiated Rate $326.04
Max. Negotiated Rate $520.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $509.60
Rate for Payer: Altius Auto/Workers Compensation $499.20
Rate for Payer: Altius Commercial $499.20
Rate for Payer: Beech Street Commercial $509.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $426.92
Rate for Payer: Cash Price $364.00
Rate for Payer: ChoiceCare Network Commercial $504.40
Rate for Payer: Cigna of WY Commercial $509.60
Rate for Payer: Entrust Commercial $494.00
Rate for Payer: First Choice Health Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $494.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $343.20
Rate for Payer: HealthUtah PPO $520.00
Rate for Payer: Idaho Integrated Healthcare Commercial $504.40
Rate for Payer: Multiplan Medicare/VA $326.04
Rate for Payer: One Health Plan of WY PPO $509.60
Rate for Payer: PacificSource Commercial $468.00
Rate for Payer: PHCS PPO $509.60
Rate for Payer: Three Rivers PPO $390.00
Rate for Payer: TriWest Veterans Administration $343.20
Rate for Payer: United Healthcare Commercial $452.40
Rate for Payer: United Healthcare Medicare $343.20
Rate for Payer: WINHealth Partners Commercial $494.00
Rate for Payer: Wise Provider Network Commercial $494.00
Hospital Charge Code 7220000003
Hospital Revenue Code 722
Min. Negotiated Rate $2,056.56
Max. Negotiated Rate $3,280.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,214.40
Rate for Payer: Altius Auto/Workers Compensation $3,148.80
Rate for Payer: Altius Commercial $3,148.80
Rate for Payer: Beech Street Commercial $3,214.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,692.88
Rate for Payer: Cash Price $2,296.00
Rate for Payer: ChoiceCare Network Commercial $3,181.60
Rate for Payer: Cigna of WY Commercial $3,214.40
Rate for Payer: Entrust Commercial $3,116.00
Rate for Payer: First Choice Health Commercial $3,116.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,116.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,164.80
Rate for Payer: HealthUtah PPO $3,280.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,181.60
Rate for Payer: Multiplan Medicare/VA $2,056.56
Rate for Payer: One Health Plan of WY PPO $3,214.40
Rate for Payer: PacificSource Commercial $2,952.00
Rate for Payer: PHCS PPO $3,214.40
Rate for Payer: Three Rivers PPO $2,460.00
Rate for Payer: TriWest Veterans Administration $2,164.80
Rate for Payer: United Healthcare Commercial $2,853.60
Rate for Payer: United Healthcare Medicare $2,164.80
Rate for Payer: WINHealth Partners Commercial $3,116.00
Rate for Payer: Wise Provider Network Commercial $3,116.00
Hospital Charge Code 7220000003
Hospital Revenue Code 722
Min. Negotiated Rate $1,807.28
Max. Negotiated Rate $3,280.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,214.40
Rate for Payer: Aetna of WY Medicare $2,164.80
Rate for Payer: Altius Auto/Workers Compensation $3,148.80
Rate for Payer: Altius Commercial $3,148.80
Rate for Payer: Beech Street Commercial $3,214.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,692.88
Rate for Payer: Cash Price $2,296.00
Rate for Payer: ChoiceCare Network Commercial $3,181.60
Rate for Payer: Cigna of WY Commercial $3,214.40
Rate for Payer: Entrust Commercial $3,116.00
Rate for Payer: First Choice Health Commercial $3,116.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,116.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,902.40
Rate for Payer: HealthUtah PPO $3,280.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,181.60
Rate for Payer: Multiplan Medicare/VA $1,807.28
Rate for Payer: One Health Plan of WY PPO $3,214.40
Rate for Payer: PacificSource Commercial $2,952.00
Rate for Payer: PHCS PPO $3,214.40
Rate for Payer: Three Rivers PPO $2,460.00
Rate for Payer: TriWest Veterans Administration $1,902.40
Rate for Payer: United Healthcare Commercial $2,853.60
Rate for Payer: United Healthcare Medicare $1,902.40
Rate for Payer: WINHealth Partners Commercial $3,214.40
Rate for Payer: Wise Provider Network Commercial $3,116.00
Service Code HCPCS 80165
Hospital Charge Code 3018016501
Hospital Revenue Code 301
Min. Negotiated Rate $93.67
Max. Negotiated Rate $170.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $166.60
Rate for Payer: Aetna of WY Medicare $112.20
Rate for Payer: Altius Auto/Workers Compensation $163.20
Rate for Payer: Altius Commercial $163.20
Rate for Payer: Beech Street Commercial $166.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $139.57
Rate for Payer: Cash Price $119.00
Rate for Payer: ChoiceCare Network Commercial $164.90
Rate for Payer: Cigna of WY Commercial $166.60
Rate for Payer: Entrust Commercial $161.50
Rate for Payer: First Choice Health Commercial $161.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $161.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $98.60
Rate for Payer: HealthUtah PPO $170.00
Rate for Payer: Idaho Integrated Healthcare Commercial $164.90
Rate for Payer: Multiplan Medicare/VA $93.67
Rate for Payer: One Health Plan of WY PPO $166.60
Rate for Payer: PacificSource Commercial $153.00
Rate for Payer: PHCS PPO $166.60
Rate for Payer: Three Rivers PPO $127.50
Rate for Payer: TriWest Veterans Administration $98.60
Rate for Payer: United Healthcare Commercial $147.90
Rate for Payer: United Healthcare Medicare $98.60
Rate for Payer: WINHealth Partners Commercial $166.60
Rate for Payer: Wise Provider Network Commercial $161.50
Service Code HCPCS 80165
Hospital Charge Code 3018016501
Hospital Revenue Code 301
Min. Negotiated Rate $106.59
Max. Negotiated Rate $170.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $166.60
Rate for Payer: Altius Auto/Workers Compensation $163.20
Rate for Payer: Altius Commercial $163.20
Rate for Payer: Beech Street Commercial $166.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $139.57
Rate for Payer: Cash Price $119.00
Rate for Payer: ChoiceCare Network Commercial $164.90
Rate for Payer: Cigna of WY Commercial $166.60
Rate for Payer: Entrust Commercial $161.50
Rate for Payer: First Choice Health Commercial $161.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $161.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $112.20
Rate for Payer: HealthUtah PPO $170.00
Rate for Payer: Idaho Integrated Healthcare Commercial $164.90
Rate for Payer: Multiplan Medicare/VA $106.59
Rate for Payer: One Health Plan of WY PPO $166.60
Rate for Payer: PacificSource Commercial $153.00
Rate for Payer: PHCS PPO $166.60
Rate for Payer: Three Rivers PPO $127.50
Rate for Payer: TriWest Veterans Administration $112.20
Rate for Payer: United Healthcare Commercial $147.90
Rate for Payer: United Healthcare Medicare $112.20
Rate for Payer: WINHealth Partners Commercial $161.50
Rate for Payer: Wise Provider Network Commercial $161.50
Service Code HCPCS 87290
Hospital Charge Code 3068729001
Hospital Revenue Code 306
Min. Negotiated Rate $104.69
Max. Negotiated Rate $190.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $186.20
Rate for Payer: Aetna of WY Medicare $125.40
Rate for Payer: Altius Auto/Workers Compensation $182.40
Rate for Payer: Altius Commercial $182.40
Rate for Payer: Beech Street Commercial $186.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $155.99
Rate for Payer: Cash Price $133.00
Rate for Payer: ChoiceCare Network Commercial $184.30
Rate for Payer: Cigna of WY Commercial $186.20
Rate for Payer: Entrust Commercial $180.50
Rate for Payer: First Choice Health Commercial $180.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $180.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $110.20
Rate for Payer: HealthUtah PPO $190.00
Rate for Payer: Idaho Integrated Healthcare Commercial $184.30
Rate for Payer: Multiplan Medicare/VA $104.69
Rate for Payer: One Health Plan of WY PPO $186.20
Rate for Payer: PacificSource Commercial $171.00
Rate for Payer: PHCS PPO $186.20
Rate for Payer: Three Rivers PPO $142.50
Rate for Payer: TriWest Veterans Administration $110.20
Rate for Payer: United Healthcare Commercial $165.30
Rate for Payer: United Healthcare Medicare $110.20
Rate for Payer: WINHealth Partners Commercial $186.20
Rate for Payer: Wise Provider Network Commercial $180.50
Service Code HCPCS 87290
Hospital Charge Code 3068729001
Hospital Revenue Code 306
Min. Negotiated Rate $119.13
Max. Negotiated Rate $190.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $186.20
Rate for Payer: Altius Auto/Workers Compensation $182.40
Rate for Payer: Altius Commercial $182.40
Rate for Payer: Beech Street Commercial $186.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $155.99
Rate for Payer: Cash Price $133.00
Rate for Payer: ChoiceCare Network Commercial $184.30
Rate for Payer: Cigna of WY Commercial $186.20
Rate for Payer: Entrust Commercial $180.50
Rate for Payer: First Choice Health Commercial $180.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $180.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $125.40
Rate for Payer: HealthUtah PPO $190.00
Rate for Payer: Idaho Integrated Healthcare Commercial $184.30
Rate for Payer: Multiplan Medicare/VA $119.13
Rate for Payer: One Health Plan of WY PPO $186.20
Rate for Payer: PacificSource Commercial $171.00
Rate for Payer: PHCS PPO $186.20
Rate for Payer: Three Rivers PPO $142.50
Rate for Payer: TriWest Veterans Administration $125.40
Rate for Payer: United Healthcare Commercial $165.30
Rate for Payer: United Healthcare Medicare $125.40
Rate for Payer: WINHealth Partners Commercial $180.50
Rate for Payer: Wise Provider Network Commercial $180.50
Service Code HCPCS 86787
Hospital Charge Code 3028678701
Hospital Revenue Code 302
Min. Negotiated Rate $79.90
Max. Negotiated Rate $145.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $142.10
Rate for Payer: Aetna of WY Medicare $95.70
Rate for Payer: Altius Auto/Workers Compensation $139.20
Rate for Payer: Altius Commercial $139.20
Rate for Payer: Beech Street Commercial $142.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $119.04
Rate for Payer: Cash Price $101.50
Rate for Payer: ChoiceCare Network Commercial $140.65
Rate for Payer: Cigna of WY Commercial $142.10
Rate for Payer: Entrust Commercial $137.75
Rate for Payer: First Choice Health Commercial $137.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $137.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $84.10
Rate for Payer: HealthUtah PPO $145.00
Rate for Payer: Idaho Integrated Healthcare Commercial $140.65
Rate for Payer: Multiplan Medicare/VA $79.90
Rate for Payer: One Health Plan of WY PPO $142.10
Rate for Payer: PacificSource Commercial $130.50
Rate for Payer: PHCS PPO $142.10
Rate for Payer: Three Rivers PPO $108.75
Rate for Payer: TriWest Veterans Administration $84.10
Rate for Payer: United Healthcare Commercial $126.15
Rate for Payer: United Healthcare Medicare $84.10
Rate for Payer: WINHealth Partners Commercial $142.10
Rate for Payer: Wise Provider Network Commercial $137.75
Service Code HCPCS 86787
Hospital Charge Code 3028678701
Hospital Revenue Code 302
Min. Negotiated Rate $90.92
Max. Negotiated Rate $145.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $142.10
Rate for Payer: Altius Auto/Workers Compensation $139.20
Rate for Payer: Altius Commercial $139.20
Rate for Payer: Beech Street Commercial $142.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $119.04
Rate for Payer: Cash Price $101.50
Rate for Payer: ChoiceCare Network Commercial $140.65
Rate for Payer: Cigna of WY Commercial $142.10
Rate for Payer: Entrust Commercial $137.75
Rate for Payer: First Choice Health Commercial $137.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $137.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $95.70
Rate for Payer: HealthUtah PPO $145.00
Rate for Payer: Idaho Integrated Healthcare Commercial $140.65
Rate for Payer: Multiplan Medicare/VA $90.92
Rate for Payer: One Health Plan of WY PPO $142.10
Rate for Payer: PacificSource Commercial $130.50
Rate for Payer: PHCS PPO $142.10
Rate for Payer: Three Rivers PPO $108.75
Rate for Payer: TriWest Veterans Administration $95.70
Rate for Payer: United Healthcare Commercial $126.15
Rate for Payer: United Healthcare Medicare $95.70
Rate for Payer: WINHealth Partners Commercial $137.75
Rate for Payer: Wise Provider Network Commercial $137.75
Service Code HCPCS 86787
Hospital Charge Code 3028678702
Hospital Revenue Code 302
Min. Negotiated Rate $79.90
Max. Negotiated Rate $145.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $142.10
Rate for Payer: Aetna of WY Medicare $95.70
Rate for Payer: Altius Auto/Workers Compensation $139.20
Rate for Payer: Altius Commercial $139.20
Rate for Payer: Beech Street Commercial $142.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $119.04
Rate for Payer: Cash Price $101.50
Rate for Payer: ChoiceCare Network Commercial $140.65
Rate for Payer: Cigna of WY Commercial $142.10
Rate for Payer: Entrust Commercial $137.75
Rate for Payer: First Choice Health Commercial $137.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $137.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $84.10
Rate for Payer: HealthUtah PPO $145.00
Rate for Payer: Idaho Integrated Healthcare Commercial $140.65
Rate for Payer: Multiplan Medicare/VA $79.90
Rate for Payer: One Health Plan of WY PPO $142.10
Rate for Payer: PacificSource Commercial $130.50
Rate for Payer: PHCS PPO $142.10
Rate for Payer: Three Rivers PPO $108.75
Rate for Payer: TriWest Veterans Administration $84.10
Rate for Payer: United Healthcare Commercial $126.15
Rate for Payer: United Healthcare Medicare $84.10
Rate for Payer: WINHealth Partners Commercial $142.10
Rate for Payer: Wise Provider Network Commercial $137.75
Service Code HCPCS 86787
Hospital Charge Code 3028678702
Hospital Revenue Code 302
Min. Negotiated Rate $90.92
Max. Negotiated Rate $145.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $142.10
Rate for Payer: Altius Auto/Workers Compensation $139.20
Rate for Payer: Altius Commercial $139.20
Rate for Payer: Beech Street Commercial $142.10
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $119.04
Rate for Payer: Cash Price $101.50
Rate for Payer: ChoiceCare Network Commercial $140.65
Rate for Payer: Cigna of WY Commercial $142.10
Rate for Payer: Entrust Commercial $137.75
Rate for Payer: First Choice Health Commercial $137.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $137.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $95.70
Rate for Payer: HealthUtah PPO $145.00
Rate for Payer: Idaho Integrated Healthcare Commercial $140.65
Rate for Payer: Multiplan Medicare/VA $90.92
Rate for Payer: One Health Plan of WY PPO $142.10
Rate for Payer: PacificSource Commercial $130.50
Rate for Payer: PHCS PPO $142.10
Rate for Payer: Three Rivers PPO $108.75
Rate for Payer: TriWest Veterans Administration $95.70
Rate for Payer: United Healthcare Commercial $126.15
Rate for Payer: United Healthcare Medicare $95.70
Rate for Payer: WINHealth Partners Commercial $137.75
Rate for Payer: Wise Provider Network Commercial $137.75
Service Code HCPCS 93975
Hospital Charge Code 9219397504
Hospital Revenue Code 921
Min. Negotiated Rate $551.00
Max. Negotiated Rate $1,000.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $980.00
Rate for Payer: Aetna of WY Medicare $660.00
Rate for Payer: Altius Auto/Workers Compensation $960.00
Rate for Payer: Altius Commercial $960.00
Rate for Payer: Beech Street Commercial $980.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $821.00
Rate for Payer: Cash Price $700.00
Rate for Payer: ChoiceCare Network Commercial $970.00
Rate for Payer: Cigna of WY Commercial $980.00
Rate for Payer: Entrust Commercial $950.00
Rate for Payer: First Choice Health Commercial $950.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $950.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $580.00
Rate for Payer: HealthUtah PPO $1,000.00
Rate for Payer: Idaho Integrated Healthcare Commercial $970.00
Rate for Payer: Multiplan Medicare/VA $551.00
Rate for Payer: One Health Plan of WY PPO $980.00
Rate for Payer: PacificSource Commercial $900.00
Rate for Payer: PHCS PPO $980.00
Rate for Payer: Three Rivers PPO $750.00
Rate for Payer: TriWest Veterans Administration $580.00
Rate for Payer: United Healthcare Commercial $870.00
Rate for Payer: United Healthcare Medicare $580.00
Rate for Payer: WINHealth Partners Commercial $980.00
Rate for Payer: Wise Provider Network Commercial $950.00
Service Code HCPCS 93975
Hospital Charge Code 9219397504
Hospital Revenue Code 921
Min. Negotiated Rate $627.00
Max. Negotiated Rate $1,000.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $980.00
Rate for Payer: Altius Auto/Workers Compensation $960.00
Rate for Payer: Altius Commercial $960.00
Rate for Payer: Beech Street Commercial $980.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $821.00
Rate for Payer: Cash Price $700.00
Rate for Payer: ChoiceCare Network Commercial $970.00
Rate for Payer: Cigna of WY Commercial $980.00
Rate for Payer: Entrust Commercial $950.00
Rate for Payer: First Choice Health Commercial $950.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $950.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $660.00
Rate for Payer: HealthUtah PPO $1,000.00
Rate for Payer: Idaho Integrated Healthcare Commercial $970.00
Rate for Payer: Multiplan Medicare/VA $627.00
Rate for Payer: One Health Plan of WY PPO $980.00
Rate for Payer: PacificSource Commercial $900.00
Rate for Payer: PHCS PPO $980.00
Rate for Payer: Three Rivers PPO $750.00
Rate for Payer: TriWest Veterans Administration $660.00
Rate for Payer: United Healthcare Commercial $870.00
Rate for Payer: United Healthcare Medicare $660.00
Rate for Payer: WINHealth Partners Commercial $950.00
Rate for Payer: Wise Provider Network Commercial $950.00
Service Code HCPCS 93970
Hospital Charge Code 9219397006
Hospital Revenue Code 921
Min. Negotiated Rate $990.66
Max. Negotiated Rate $1,580.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,548.40
Rate for Payer: Altius Auto/Workers Compensation $1,516.80
Rate for Payer: Altius Commercial $1,516.80
Rate for Payer: Beech Street Commercial $1,548.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,297.18
Rate for Payer: Cash Price $1,106.00
Rate for Payer: ChoiceCare Network Commercial $1,532.60
Rate for Payer: Cigna of WY Commercial $1,548.40
Rate for Payer: Entrust Commercial $1,501.00
Rate for Payer: First Choice Health Commercial $1,501.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,501.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,042.80
Rate for Payer: HealthUtah PPO $1,580.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,532.60
Rate for Payer: Multiplan Medicare/VA $990.66
Rate for Payer: One Health Plan of WY PPO $1,548.40
Rate for Payer: PacificSource Commercial $1,422.00
Rate for Payer: PHCS PPO $1,548.40
Rate for Payer: Three Rivers PPO $1,185.00
Rate for Payer: TriWest Veterans Administration $1,042.80
Rate for Payer: United Healthcare Commercial $1,374.60
Rate for Payer: United Healthcare Medicare $1,042.80
Rate for Payer: WINHealth Partners Commercial $1,501.00
Rate for Payer: Wise Provider Network Commercial $1,501.00
Service Code HCPCS 93970
Hospital Charge Code 9219397006
Hospital Revenue Code 921
Min. Negotiated Rate $870.58
Max. Negotiated Rate $1,580.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,548.40
Rate for Payer: Aetna of WY Medicare $1,042.80
Rate for Payer: Altius Auto/Workers Compensation $1,516.80
Rate for Payer: Altius Commercial $1,516.80
Rate for Payer: Beech Street Commercial $1,548.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,297.18
Rate for Payer: Cash Price $1,106.00
Rate for Payer: ChoiceCare Network Commercial $1,532.60
Rate for Payer: Cigna of WY Commercial $1,548.40
Rate for Payer: Entrust Commercial $1,501.00
Rate for Payer: First Choice Health Commercial $1,501.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,501.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $916.40
Rate for Payer: HealthUtah PPO $1,580.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,532.60
Rate for Payer: Multiplan Medicare/VA $870.58
Rate for Payer: One Health Plan of WY PPO $1,548.40
Rate for Payer: PacificSource Commercial $1,422.00
Rate for Payer: PHCS PPO $1,548.40
Rate for Payer: Three Rivers PPO $1,185.00
Rate for Payer: TriWest Veterans Administration $916.40
Rate for Payer: United Healthcare Commercial $1,374.60
Rate for Payer: United Healthcare Medicare $916.40
Rate for Payer: WINHealth Partners Commercial $1,548.40
Rate for Payer: Wise Provider Network Commercial $1,501.00
Service Code HCPCS 93990
Hospital Charge Code 9219399002
Hospital Revenue Code 921
Min. Negotiated Rate $288.42
Max. Negotiated Rate $460.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $450.80
Rate for Payer: Altius Auto/Workers Compensation $441.60
Rate for Payer: Altius Commercial $441.60
Rate for Payer: Beech Street Commercial $450.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $377.66
Rate for Payer: Cash Price $322.00
Rate for Payer: ChoiceCare Network Commercial $446.20
Rate for Payer: Cigna of WY Commercial $450.80
Rate for Payer: Entrust Commercial $437.00
Rate for Payer: First Choice Health Commercial $437.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $437.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $303.60
Rate for Payer: HealthUtah PPO $460.00
Rate for Payer: Idaho Integrated Healthcare Commercial $446.20
Rate for Payer: Multiplan Medicare/VA $288.42
Rate for Payer: One Health Plan of WY PPO $450.80
Rate for Payer: PacificSource Commercial $414.00
Rate for Payer: PHCS PPO $450.80
Rate for Payer: Three Rivers PPO $345.00
Rate for Payer: TriWest Veterans Administration $303.60
Rate for Payer: United Healthcare Commercial $400.20
Rate for Payer: United Healthcare Medicare $303.60
Rate for Payer: WINHealth Partners Commercial $437.00
Rate for Payer: Wise Provider Network Commercial $437.00
Service Code HCPCS 93990
Hospital Charge Code 9219399002
Hospital Revenue Code 921
Min. Negotiated Rate $253.46
Max. Negotiated Rate $460.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $450.80
Rate for Payer: Aetna of WY Medicare $303.60
Rate for Payer: Altius Auto/Workers Compensation $441.60
Rate for Payer: Altius Commercial $441.60
Rate for Payer: Beech Street Commercial $450.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $377.66
Rate for Payer: Cash Price $322.00
Rate for Payer: ChoiceCare Network Commercial $446.20
Rate for Payer: Cigna of WY Commercial $450.80
Rate for Payer: Entrust Commercial $437.00
Rate for Payer: First Choice Health Commercial $437.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $437.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $266.80
Rate for Payer: HealthUtah PPO $460.00
Rate for Payer: Idaho Integrated Healthcare Commercial $446.20
Rate for Payer: Multiplan Medicare/VA $253.46
Rate for Payer: One Health Plan of WY PPO $450.80
Rate for Payer: PacificSource Commercial $414.00
Rate for Payer: PHCS PPO $450.80
Rate for Payer: Three Rivers PPO $345.00
Rate for Payer: TriWest Veterans Administration $266.80
Rate for Payer: United Healthcare Commercial $400.20
Rate for Payer: United Healthcare Medicare $266.80
Rate for Payer: WINHealth Partners Commercial $450.80
Rate for Payer: Wise Provider Network Commercial $437.00
Service Code HCPCS 93926
Hospital Charge Code 9219392603
Hospital Revenue Code 921
Min. Negotiated Rate $495.90
Max. Negotiated Rate $900.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $882.00
Rate for Payer: Aetna of WY Medicare $594.00
Rate for Payer: Altius Auto/Workers Compensation $864.00
Rate for Payer: Altius Commercial $864.00
Rate for Payer: Beech Street Commercial $882.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $738.90
Rate for Payer: Cash Price $630.00
Rate for Payer: ChoiceCare Network Commercial $873.00
Rate for Payer: Cigna of WY Commercial $882.00
Rate for Payer: Entrust Commercial $855.00
Rate for Payer: First Choice Health Commercial $855.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $855.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $522.00
Rate for Payer: HealthUtah PPO $900.00
Rate for Payer: Idaho Integrated Healthcare Commercial $873.00
Rate for Payer: Multiplan Medicare/VA $495.90
Rate for Payer: One Health Plan of WY PPO $882.00
Rate for Payer: PacificSource Commercial $810.00
Rate for Payer: PHCS PPO $882.00
Rate for Payer: Three Rivers PPO $675.00
Rate for Payer: TriWest Veterans Administration $522.00
Rate for Payer: United Healthcare Commercial $783.00
Rate for Payer: United Healthcare Medicare $522.00
Rate for Payer: WINHealth Partners Commercial $882.00
Rate for Payer: Wise Provider Network Commercial $855.00
Service Code HCPCS 93926
Hospital Charge Code 9219392603
Hospital Revenue Code 921
Min. Negotiated Rate $564.30
Max. Negotiated Rate $900.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $882.00
Rate for Payer: Altius Auto/Workers Compensation $864.00
Rate for Payer: Altius Commercial $864.00
Rate for Payer: Beech Street Commercial $882.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $738.90
Rate for Payer: Cash Price $630.00
Rate for Payer: ChoiceCare Network Commercial $873.00
Rate for Payer: Cigna of WY Commercial $882.00
Rate for Payer: Entrust Commercial $855.00
Rate for Payer: First Choice Health Commercial $855.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $855.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $594.00
Rate for Payer: HealthUtah PPO $900.00
Rate for Payer: Idaho Integrated Healthcare Commercial $873.00
Rate for Payer: Multiplan Medicare/VA $564.30
Rate for Payer: One Health Plan of WY PPO $882.00
Rate for Payer: PacificSource Commercial $810.00
Rate for Payer: PHCS PPO $882.00
Rate for Payer: Three Rivers PPO $675.00
Rate for Payer: TriWest Veterans Administration $594.00
Rate for Payer: United Healthcare Commercial $783.00
Rate for Payer: United Healthcare Medicare $594.00
Rate for Payer: WINHealth Partners Commercial $855.00
Rate for Payer: Wise Provider Network Commercial $855.00
Service Code HCPCS 93930
Hospital Charge Code 9219393006
Hospital Revenue Code 921
Min. Negotiated Rate $512.43
Max. Negotiated Rate $930.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $911.40
Rate for Payer: Aetna of WY Medicare $613.80
Rate for Payer: Altius Auto/Workers Compensation $892.80
Rate for Payer: Altius Commercial $892.80
Rate for Payer: Beech Street Commercial $911.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $763.53
Rate for Payer: Cash Price $651.00
Rate for Payer: ChoiceCare Network Commercial $902.10
Rate for Payer: Cigna of WY Commercial $911.40
Rate for Payer: Entrust Commercial $883.50
Rate for Payer: First Choice Health Commercial $883.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $883.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $539.40
Rate for Payer: HealthUtah PPO $930.00
Rate for Payer: Idaho Integrated Healthcare Commercial $902.10
Rate for Payer: Multiplan Medicare/VA $512.43
Rate for Payer: One Health Plan of WY PPO $911.40
Rate for Payer: PacificSource Commercial $837.00
Rate for Payer: PHCS PPO $911.40
Rate for Payer: Three Rivers PPO $697.50
Rate for Payer: TriWest Veterans Administration $539.40
Rate for Payer: United Healthcare Commercial $809.10
Rate for Payer: United Healthcare Medicare $539.40
Rate for Payer: WINHealth Partners Commercial $911.40
Rate for Payer: Wise Provider Network Commercial $883.50
Service Code HCPCS 93930
Hospital Charge Code 9219393006
Hospital Revenue Code 921
Min. Negotiated Rate $583.11
Max. Negotiated Rate $930.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $911.40
Rate for Payer: Altius Auto/Workers Compensation $892.80
Rate for Payer: Altius Commercial $892.80
Rate for Payer: Beech Street Commercial $911.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $763.53
Rate for Payer: Cash Price $651.00
Rate for Payer: ChoiceCare Network Commercial $902.10
Rate for Payer: Cigna of WY Commercial $911.40
Rate for Payer: Entrust Commercial $883.50
Rate for Payer: First Choice Health Commercial $883.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $883.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $613.80
Rate for Payer: HealthUtah PPO $930.00
Rate for Payer: Idaho Integrated Healthcare Commercial $902.10
Rate for Payer: Multiplan Medicare/VA $583.11
Rate for Payer: One Health Plan of WY PPO $911.40
Rate for Payer: PacificSource Commercial $837.00
Rate for Payer: PHCS PPO $911.40
Rate for Payer: Three Rivers PPO $697.50
Rate for Payer: TriWest Veterans Administration $613.80
Rate for Payer: United Healthcare Commercial $809.10
Rate for Payer: United Healthcare Medicare $613.80
Rate for Payer: WINHealth Partners Commercial $883.50
Rate for Payer: Wise Provider Network Commercial $883.50
Service Code HCPCS 93924
Hospital Charge Code 9219392401
Hospital Revenue Code 921
Min. Negotiated Rate $314.07
Max. Negotiated Rate $570.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $558.60
Rate for Payer: Aetna of WY Medicare $376.20
Rate for Payer: Altius Auto/Workers Compensation $547.20
Rate for Payer: Altius Commercial $547.20
Rate for Payer: Beech Street Commercial $558.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $467.97
Rate for Payer: Cash Price $399.00
Rate for Payer: ChoiceCare Network Commercial $552.90
Rate for Payer: Cigna of WY Commercial $558.60
Rate for Payer: Entrust Commercial $541.50
Rate for Payer: First Choice Health Commercial $541.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $541.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $330.60
Rate for Payer: HealthUtah PPO $570.00
Rate for Payer: Idaho Integrated Healthcare Commercial $552.90
Rate for Payer: Multiplan Medicare/VA $314.07
Rate for Payer: One Health Plan of WY PPO $558.60
Rate for Payer: PacificSource Commercial $513.00
Rate for Payer: PHCS PPO $558.60
Rate for Payer: Three Rivers PPO $427.50
Rate for Payer: TriWest Veterans Administration $330.60
Rate for Payer: United Healthcare Commercial $495.90
Rate for Payer: United Healthcare Medicare $330.60
Rate for Payer: WINHealth Partners Commercial $558.60
Rate for Payer: Wise Provider Network Commercial $541.50
Service Code HCPCS 93924
Hospital Charge Code 9219392401
Hospital Revenue Code 921
Min. Negotiated Rate $357.39
Max. Negotiated Rate $570.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $558.60
Rate for Payer: Altius Auto/Workers Compensation $547.20
Rate for Payer: Altius Commercial $547.20
Rate for Payer: Beech Street Commercial $558.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $467.97
Rate for Payer: Cash Price $399.00
Rate for Payer: ChoiceCare Network Commercial $552.90
Rate for Payer: Cigna of WY Commercial $558.60
Rate for Payer: Entrust Commercial $541.50
Rate for Payer: First Choice Health Commercial $541.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $541.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $376.20
Rate for Payer: HealthUtah PPO $570.00
Rate for Payer: Idaho Integrated Healthcare Commercial $552.90
Rate for Payer: Multiplan Medicare/VA $357.39
Rate for Payer: One Health Plan of WY PPO $558.60
Rate for Payer: PacificSource Commercial $513.00
Rate for Payer: PHCS PPO $558.60
Rate for Payer: Three Rivers PPO $427.50
Rate for Payer: TriWest Veterans Administration $376.20
Rate for Payer: United Healthcare Commercial $495.90
Rate for Payer: United Healthcare Medicare $376.20
Rate for Payer: WINHealth Partners Commercial $541.50
Rate for Payer: Wise Provider Network Commercial $541.50
Service Code HCPCS 93922
Hospital Charge Code 9219392203
Hospital Revenue Code 921
Min. Negotiated Rate $385.70
Max. Negotiated Rate $700.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $686.00
Rate for Payer: Aetna of WY Medicare $462.00
Rate for Payer: Altius Auto/Workers Compensation $672.00
Rate for Payer: Altius Commercial $672.00
Rate for Payer: Beech Street Commercial $686.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $574.70
Rate for Payer: Cash Price $490.00
Rate for Payer: ChoiceCare Network Commercial $679.00
Rate for Payer: Cigna of WY Commercial $686.00
Rate for Payer: Entrust Commercial $665.00
Rate for Payer: First Choice Health Commercial $665.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $665.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $406.00
Rate for Payer: HealthUtah PPO $700.00
Rate for Payer: Idaho Integrated Healthcare Commercial $679.00
Rate for Payer: Multiplan Medicare/VA $385.70
Rate for Payer: One Health Plan of WY PPO $686.00
Rate for Payer: PacificSource Commercial $630.00
Rate for Payer: PHCS PPO $686.00
Rate for Payer: Three Rivers PPO $525.00
Rate for Payer: TriWest Veterans Administration $406.00
Rate for Payer: United Healthcare Commercial $609.00
Rate for Payer: United Healthcare Medicare $406.00
Rate for Payer: WINHealth Partners Commercial $686.00
Rate for Payer: Wise Provider Network Commercial $665.00
Service Code HCPCS 93922
Hospital Charge Code 9219392203
Hospital Revenue Code 921
Min. Negotiated Rate $438.90
Max. Negotiated Rate $700.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $686.00
Rate for Payer: Altius Auto/Workers Compensation $672.00
Rate for Payer: Altius Commercial $672.00
Rate for Payer: Beech Street Commercial $686.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $574.70
Rate for Payer: Cash Price $490.00
Rate for Payer: ChoiceCare Network Commercial $679.00
Rate for Payer: Cigna of WY Commercial $686.00
Rate for Payer: Entrust Commercial $665.00
Rate for Payer: First Choice Health Commercial $665.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $665.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $462.00
Rate for Payer: HealthUtah PPO $700.00
Rate for Payer: Idaho Integrated Healthcare Commercial $679.00
Rate for Payer: Multiplan Medicare/VA $438.90
Rate for Payer: One Health Plan of WY PPO $686.00
Rate for Payer: PacificSource Commercial $630.00
Rate for Payer: PHCS PPO $686.00
Rate for Payer: Three Rivers PPO $525.00
Rate for Payer: TriWest Veterans Administration $462.00
Rate for Payer: United Healthcare Commercial $609.00
Rate for Payer: United Healthcare Medicare $462.00
Rate for Payer: WINHealth Partners Commercial $665.00
Rate for Payer: Wise Provider Network Commercial $665.00