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Service Code HCPCS J1171
Hospital Revenue Code 636
Min. Negotiated Rate $19.56
Max. Negotiated Rate $31.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.58
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.72
Rate for Payer: Altius Auto/Workers Compensation $29.95
Rate for Payer: Altius Auto/Workers Compensation $25.20
Rate for Payer: Altius Commercial $25.20
Rate for Payer: Altius Commercial $29.95
Rate for Payer: Beech Street Commercial $30.58
Rate for Payer: Beech Street Commercial $25.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.55
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.62
Rate for Payer: Cash Price $21.84
Rate for Payer: Cash Price $18.38
Rate for Payer: ChoiceCare Network Commercial $25.46
Rate for Payer: ChoiceCare Network Commercial $30.26
Rate for Payer: Cigna of WY Commercial $30.58
Rate for Payer: Cigna of WY Commercial $25.72
Rate for Payer: Entrust Commercial $24.94
Rate for Payer: Entrust Commercial $29.64
Rate for Payer: First Choice Health Commercial $24.94
Rate for Payer: First Choice Health Commercial $29.64
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.94
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.64
Rate for Payer: Government Employees Health Association (GEHA) Medicare $20.59
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.32
Rate for Payer: HealthUtah PPO $31.20
Rate for Payer: HealthUtah PPO $26.25
Rate for Payer: Idaho Integrated Healthcare Commercial $25.46
Rate for Payer: Idaho Integrated Healthcare Commercial $30.26
Rate for Payer: Multiplan Medicare/VA $19.56
Rate for Payer: Multiplan Medicare/VA $16.46
Rate for Payer: One Health Plan of WY PPO $30.58
Rate for Payer: One Health Plan of WY PPO $25.72
Rate for Payer: PacificSource Commercial $28.08
Rate for Payer: PacificSource Commercial $23.62
Rate for Payer: PHCS PPO $25.72
Rate for Payer: PHCS PPO $30.58
Rate for Payer: Three Rivers PPO $19.69
Rate for Payer: Three Rivers PPO $23.40
Rate for Payer: TriWest Veterans Administration $20.59
Rate for Payer: TriWest Veterans Administration $17.32
Rate for Payer: United Healthcare Commercial $22.84
Rate for Payer: United Healthcare Commercial $27.14
Rate for Payer: United Healthcare Medicare $20.59
Rate for Payer: United Healthcare Medicare $17.32
Rate for Payer: WINHealth Partners Commercial $24.94
Rate for Payer: WINHealth Partners Commercial $29.64
Rate for Payer: Wise Provider Network Commercial $24.94
Rate for Payer: Wise Provider Network Commercial $29.64
Service Code HCPCS J1171
Hospital Revenue Code 636
Min. Negotiated Rate $17.19
Max. Negotiated Rate $31.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.58
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.72
Rate for Payer: Aetna of WY Medicare $20.59
Rate for Payer: Aetna of WY Medicare $17.32
Rate for Payer: Altius Auto/Workers Compensation $25.20
Rate for Payer: Altius Auto/Workers Compensation $29.95
Rate for Payer: Altius Commercial $29.95
Rate for Payer: Altius Commercial $25.20
Rate for Payer: Beech Street Commercial $25.72
Rate for Payer: Beech Street Commercial $30.58
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.55
Rate for Payer: Cash Price $18.38
Rate for Payer: Cash Price $21.84
Rate for Payer: ChoiceCare Network Commercial $30.26
Rate for Payer: ChoiceCare Network Commercial $25.46
Rate for Payer: Cigna of WY Commercial $25.72
Rate for Payer: Cigna of WY Commercial $30.58
Rate for Payer: Entrust Commercial $29.64
Rate for Payer: Entrust Commercial $24.94
Rate for Payer: First Choice Health Commercial $24.94
Rate for Payer: First Choice Health Commercial $29.64
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.94
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.64
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $15.22
Rate for Payer: HealthUtah PPO $26.25
Rate for Payer: HealthUtah PPO $31.20
Rate for Payer: Idaho Integrated Healthcare Commercial $25.46
Rate for Payer: Idaho Integrated Healthcare Commercial $30.26
Rate for Payer: Multiplan Medicare/VA $17.19
Rate for Payer: Multiplan Medicare/VA $14.46
Rate for Payer: One Health Plan of WY PPO $25.72
Rate for Payer: One Health Plan of WY PPO $30.58
Rate for Payer: PacificSource Commercial $28.08
Rate for Payer: PacificSource Commercial $23.62
Rate for Payer: PHCS PPO $25.72
Rate for Payer: PHCS PPO $30.58
Rate for Payer: Three Rivers PPO $19.69
Rate for Payer: Three Rivers PPO $23.40
Rate for Payer: TriWest Veterans Administration $18.10
Rate for Payer: TriWest Veterans Administration $15.22
Rate for Payer: United Healthcare Commercial $22.84
Rate for Payer: United Healthcare Commercial $27.14
Rate for Payer: United Healthcare Medicare $18.10
Rate for Payer: United Healthcare Medicare $15.22
Rate for Payer: WINHealth Partners Commercial $25.72
Rate for Payer: WINHealth Partners Commercial $30.58
Rate for Payer: Wise Provider Network Commercial $24.94
Rate for Payer: Wise Provider Network Commercial $29.64
Service Code HCPCS J3424
Hospital Revenue Code 636
Min. Negotiated Rate $558.16
Max. Negotiated Rate $1,013.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $992.74
Rate for Payer: Aetna of WY Medicare $668.58
Rate for Payer: Altius Auto/Workers Compensation $972.48
Rate for Payer: Altius Commercial $972.48
Rate for Payer: Beech Street Commercial $992.74
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $831.67
Rate for Payer: Cash Price $709.10
Rate for Payer: ChoiceCare Network Commercial $982.61
Rate for Payer: Cigna of WY Commercial $992.74
Rate for Payer: Entrust Commercial $962.35
Rate for Payer: First Choice Health Commercial $962.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $962.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $587.54
Rate for Payer: HealthUtah PPO $1,013.00
Rate for Payer: Idaho Integrated Healthcare Commercial $982.61
Rate for Payer: Multiplan Medicare/VA $558.16
Rate for Payer: One Health Plan of WY PPO $992.74
Rate for Payer: PacificSource Commercial $911.70
Rate for Payer: PHCS PPO $992.74
Rate for Payer: Three Rivers PPO $759.75
Rate for Payer: TriWest Veterans Administration $587.54
Rate for Payer: United Healthcare Commercial $881.31
Rate for Payer: United Healthcare Medicare $587.54
Rate for Payer: WINHealth Partners Commercial $992.74
Rate for Payer: Wise Provider Network Commercial $962.35
Service Code HCPCS J3424
Hospital Revenue Code 636
Min. Negotiated Rate $635.15
Max. Negotiated Rate $1,013.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $992.74
Rate for Payer: Altius Auto/Workers Compensation $972.48
Rate for Payer: Altius Commercial $972.48
Rate for Payer: Beech Street Commercial $992.74
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $831.67
Rate for Payer: Cash Price $709.10
Rate for Payer: ChoiceCare Network Commercial $982.61
Rate for Payer: Cigna of WY Commercial $992.74
Rate for Payer: Entrust Commercial $962.35
Rate for Payer: First Choice Health Commercial $962.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $962.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $668.58
Rate for Payer: HealthUtah PPO $1,013.00
Rate for Payer: Idaho Integrated Healthcare Commercial $982.61
Rate for Payer: Multiplan Medicare/VA $635.15
Rate for Payer: One Health Plan of WY PPO $992.74
Rate for Payer: PacificSource Commercial $911.70
Rate for Payer: PHCS PPO $992.74
Rate for Payer: Three Rivers PPO $759.75
Rate for Payer: TriWest Veterans Administration $668.58
Rate for Payer: United Healthcare Commercial $881.31
Rate for Payer: United Healthcare Medicare $668.58
Rate for Payer: WINHealth Partners Commercial $962.35
Rate for Payer: Wise Provider Network Commercial $962.35
Service Code NDC 6808426911
Hospital Revenue Code 250
Min. Negotiated Rate $4.89
Max. Negotiated Rate $7.80
Rate for Payer: Aetna of WY Commercial/Medical Rental $7.64
Rate for Payer: Altius Auto/Workers Compensation $7.49
Rate for Payer: Altius Commercial $7.49
Rate for Payer: Beech Street Commercial $7.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6.40
Rate for Payer: Cash Price $5.46
Rate for Payer: ChoiceCare Network Commercial $7.57
Rate for Payer: Cigna of WY Commercial $7.64
Rate for Payer: Entrust Commercial $7.41
Rate for Payer: First Choice Health Commercial $7.41
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7.41
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5.15
Rate for Payer: HealthUtah PPO $7.80
Rate for Payer: Idaho Integrated Healthcare Commercial $7.57
Rate for Payer: Multiplan Medicare/VA $4.89
Rate for Payer: One Health Plan of WY PPO $7.64
Rate for Payer: PacificSource Commercial $7.02
Rate for Payer: PHCS PPO $7.64
Rate for Payer: Three Rivers PPO $5.85
Rate for Payer: TriWest Veterans Administration $5.15
Rate for Payer: United Healthcare Commercial $6.79
Rate for Payer: United Healthcare Medicare $5.15
Rate for Payer: WINHealth Partners Commercial $7.41
Rate for Payer: Wise Provider Network Commercial $7.41
Service Code NDC 6808426911
Hospital Revenue Code 250
Min. Negotiated Rate $4.30
Max. Negotiated Rate $7.80
Rate for Payer: Aetna of WY Commercial/Medical Rental $7.64
Rate for Payer: Aetna of WY Medicare $5.15
Rate for Payer: Altius Auto/Workers Compensation $7.49
Rate for Payer: Altius Commercial $7.49
Rate for Payer: Beech Street Commercial $7.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6.40
Rate for Payer: Cash Price $5.46
Rate for Payer: ChoiceCare Network Commercial $7.57
Rate for Payer: Cigna of WY Commercial $7.64
Rate for Payer: Entrust Commercial $7.41
Rate for Payer: First Choice Health Commercial $7.41
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7.41
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4.52
Rate for Payer: HealthUtah PPO $7.80
Rate for Payer: Idaho Integrated Healthcare Commercial $7.57
Rate for Payer: Multiplan Medicare/VA $4.30
Rate for Payer: One Health Plan of WY PPO $7.64
Rate for Payer: PacificSource Commercial $7.02
Rate for Payer: PHCS PPO $7.64
Rate for Payer: Three Rivers PPO $5.85
Rate for Payer: TriWest Veterans Administration $4.52
Rate for Payer: United Healthcare Commercial $6.79
Rate for Payer: United Healthcare Medicare $4.52
Rate for Payer: WINHealth Partners Commercial $7.64
Rate for Payer: Wise Provider Network Commercial $7.41
Service Code HCPCS J1725
Hospital Charge Code J1725
Min. Negotiated Rate $3.00
Max. Negotiated Rate $4.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.92
Rate for Payer: Beech Street Commercial $3.80
Rate for Payer: Cash Price $2.80
Rate for Payer: ChoiceCare Network Commercial $3.88
Rate for Payer: Cigna of WY Commercial $3.92
Rate for Payer: First Choice Health Commercial $3.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.80
Rate for Payer: HealthUtah PPO $4.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3.88
Rate for Payer: One Health Plan of WY PPO $3.92
Rate for Payer: PacificSource Commercial $3.60
Rate for Payer: PHCS PPO $3.80
Rate for Payer: Three Rivers PPO $3.00
Rate for Payer: United Healthcare Commercial $3.48
Rate for Payer: WINHealth Partners Commercial $3.80
Service Code HCPCS J3410
Hospital Charge Code J3410
Min. Negotiated Rate $9.00
Max. Negotiated Rate $13.87
Rate for Payer: Aetna of WY Commercial/Medical Rental $11.76
Rate for Payer: Aetna of WY Medicare $13.87
Rate for Payer: Beech Street Commercial $11.40
Rate for Payer: Cash Price $8.40
Rate for Payer: Cash Price $8.40
Rate for Payer: ChoiceCare Network Commercial $11.64
Rate for Payer: Cigna of WY Commercial $11.76
Rate for Payer: First Choice Health Commercial $10.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $11.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $13.87
Rate for Payer: HealthUtah PPO $12.00
Rate for Payer: Idaho Integrated Healthcare Commercial $11.64
Rate for Payer: Multiplan Medicare/VA $11.79
Rate for Payer: One Health Plan of WY PPO $11.76
Rate for Payer: PacificSource Commercial $10.80
Rate for Payer: PHCS PPO $11.40
Rate for Payer: Three Rivers PPO $9.00
Rate for Payer: TriWest Veterans Administration $13.87
Rate for Payer: United Healthcare Commercial $10.44
Rate for Payer: United Healthcare Medicare $13.87
Rate for Payer: WINHealth Partners Commercial $11.40
Service Code NDC 6808484701
Hospital Revenue Code 250
Min. Negotiated Rate $1.10
Max. Negotiated Rate $2.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.96
Rate for Payer: Aetna of WY Medicare $1.32
Rate for Payer: Altius Auto/Workers Compensation $1.92
Rate for Payer: Altius Commercial $1.92
Rate for Payer: Beech Street Commercial $1.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.64
Rate for Payer: Cash Price $1.40
Rate for Payer: ChoiceCare Network Commercial $1.94
Rate for Payer: Cigna of WY Commercial $1.96
Rate for Payer: Entrust Commercial $1.90
Rate for Payer: First Choice Health Commercial $1.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.16
Rate for Payer: HealthUtah PPO $2.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1.94
Rate for Payer: Multiplan Medicare/VA $1.10
Rate for Payer: One Health Plan of WY PPO $1.96
Rate for Payer: PacificSource Commercial $1.80
Rate for Payer: PHCS PPO $1.96
Rate for Payer: Three Rivers PPO $1.50
Rate for Payer: TriWest Veterans Administration $1.16
Rate for Payer: United Healthcare Commercial $1.74
Rate for Payer: United Healthcare Medicare $1.16
Rate for Payer: WINHealth Partners Commercial $1.96
Rate for Payer: Wise Provider Network Commercial $1.90
Service Code NDC 6808484711
Hospital Revenue Code 250
Min. Negotiated Rate $1.25
Max. Negotiated Rate $2.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.96
Rate for Payer: Altius Auto/Workers Compensation $1.92
Rate for Payer: Altius Commercial $1.92
Rate for Payer: Beech Street Commercial $1.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.64
Rate for Payer: Cash Price $1.40
Rate for Payer: ChoiceCare Network Commercial $1.94
Rate for Payer: Cigna of WY Commercial $1.96
Rate for Payer: Entrust Commercial $1.90
Rate for Payer: First Choice Health Commercial $1.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.32
Rate for Payer: HealthUtah PPO $2.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1.94
Rate for Payer: Multiplan Medicare/VA $1.25
Rate for Payer: One Health Plan of WY PPO $1.96
Rate for Payer: PacificSource Commercial $1.80
Rate for Payer: PHCS PPO $1.96
Rate for Payer: Three Rivers PPO $1.50
Rate for Payer: TriWest Veterans Administration $1.32
Rate for Payer: United Healthcare Commercial $1.74
Rate for Payer: United Healthcare Medicare $1.32
Rate for Payer: WINHealth Partners Commercial $1.90
Rate for Payer: Wise Provider Network Commercial $1.90
Service Code NDC 6808484701
Hospital Revenue Code 250
Min. Negotiated Rate $1.25
Max. Negotiated Rate $2.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.96
Rate for Payer: Altius Auto/Workers Compensation $1.92
Rate for Payer: Altius Commercial $1.92
Rate for Payer: Beech Street Commercial $1.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.64
Rate for Payer: Cash Price $1.40
Rate for Payer: ChoiceCare Network Commercial $1.94
Rate for Payer: Cigna of WY Commercial $1.96
Rate for Payer: Entrust Commercial $1.90
Rate for Payer: First Choice Health Commercial $1.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.32
Rate for Payer: HealthUtah PPO $2.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1.94
Rate for Payer: Multiplan Medicare/VA $1.25
Rate for Payer: One Health Plan of WY PPO $1.96
Rate for Payer: PacificSource Commercial $1.80
Rate for Payer: PHCS PPO $1.96
Rate for Payer: Three Rivers PPO $1.50
Rate for Payer: TriWest Veterans Administration $1.32
Rate for Payer: United Healthcare Commercial $1.74
Rate for Payer: United Healthcare Medicare $1.32
Rate for Payer: WINHealth Partners Commercial $1.90
Rate for Payer: Wise Provider Network Commercial $1.90
Service Code NDC 6808484711
Hospital Revenue Code 250
Min. Negotiated Rate $1.10
Max. Negotiated Rate $2.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.96
Rate for Payer: Aetna of WY Medicare $1.32
Rate for Payer: Altius Auto/Workers Compensation $1.92
Rate for Payer: Altius Commercial $1.92
Rate for Payer: Beech Street Commercial $1.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.64
Rate for Payer: Cash Price $1.40
Rate for Payer: ChoiceCare Network Commercial $1.94
Rate for Payer: Cigna of WY Commercial $1.96
Rate for Payer: Entrust Commercial $1.90
Rate for Payer: First Choice Health Commercial $1.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.16
Rate for Payer: HealthUtah PPO $2.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1.94
Rate for Payer: Multiplan Medicare/VA $1.10
Rate for Payer: One Health Plan of WY PPO $1.96
Rate for Payer: PacificSource Commercial $1.80
Rate for Payer: PHCS PPO $1.96
Rate for Payer: Three Rivers PPO $1.50
Rate for Payer: TriWest Veterans Administration $1.16
Rate for Payer: United Healthcare Commercial $1.74
Rate for Payer: United Healthcare Medicare $1.16
Rate for Payer: WINHealth Partners Commercial $1.96
Rate for Payer: Wise Provider Network Commercial $1.90
Service Code NDC 6068769611
Hospital Revenue Code 250
Min. Negotiated Rate $1.06
Max. Negotiated Rate $1.92
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.88
Rate for Payer: Aetna of WY Medicare $1.27
Rate for Payer: Altius Auto/Workers Compensation $1.84
Rate for Payer: Altius Commercial $1.84
Rate for Payer: Beech Street Commercial $1.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.58
Rate for Payer: Cash Price $1.35
Rate for Payer: ChoiceCare Network Commercial $1.86
Rate for Payer: Cigna of WY Commercial $1.88
Rate for Payer: Entrust Commercial $1.82
Rate for Payer: First Choice Health Commercial $1.82
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.82
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.11
Rate for Payer: HealthUtah PPO $1.92
Rate for Payer: Idaho Integrated Healthcare Commercial $1.86
Rate for Payer: Multiplan Medicare/VA $1.06
Rate for Payer: One Health Plan of WY PPO $1.88
Rate for Payer: PacificSource Commercial $1.73
Rate for Payer: PHCS PPO $1.88
Rate for Payer: Three Rivers PPO $1.44
Rate for Payer: TriWest Veterans Administration $1.11
Rate for Payer: United Healthcare Commercial $1.67
Rate for Payer: United Healthcare Medicare $1.11
Rate for Payer: WINHealth Partners Commercial $1.88
Rate for Payer: Wise Provider Network Commercial $1.82
Service Code NDC 6068769611
Hospital Revenue Code 250
Min. Negotiated Rate $1.20
Max. Negotiated Rate $1.92
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.88
Rate for Payer: Altius Auto/Workers Compensation $1.84
Rate for Payer: Altius Commercial $1.84
Rate for Payer: Beech Street Commercial $1.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.58
Rate for Payer: Cash Price $1.35
Rate for Payer: ChoiceCare Network Commercial $1.86
Rate for Payer: Cigna of WY Commercial $1.88
Rate for Payer: Entrust Commercial $1.82
Rate for Payer: First Choice Health Commercial $1.82
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.82
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.27
Rate for Payer: HealthUtah PPO $1.92
Rate for Payer: Idaho Integrated Healthcare Commercial $1.86
Rate for Payer: Multiplan Medicare/VA $1.20
Rate for Payer: One Health Plan of WY PPO $1.88
Rate for Payer: PacificSource Commercial $1.73
Rate for Payer: PHCS PPO $1.88
Rate for Payer: Three Rivers PPO $1.44
Rate for Payer: TriWest Veterans Administration $1.27
Rate for Payer: United Healthcare Commercial $1.67
Rate for Payer: United Healthcare Medicare $1.27
Rate for Payer: WINHealth Partners Commercial $1.82
Rate for Payer: Wise Provider Network Commercial $1.82
Service Code HCPCS J7325
Hospital Revenue Code 636
Min. Negotiated Rate $165.49
Max. Negotiated Rate $300.34
Rate for Payer: Aetna of WY Commercial/Medical Rental $294.33
Rate for Payer: Aetna of WY Medicare $198.22
Rate for Payer: Altius Auto/Workers Compensation $288.33
Rate for Payer: Altius Commercial $288.33
Rate for Payer: Beech Street Commercial $294.33
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $246.58
Rate for Payer: Cash Price $210.24
Rate for Payer: ChoiceCare Network Commercial $291.33
Rate for Payer: Cigna of WY Commercial $294.33
Rate for Payer: Entrust Commercial $285.32
Rate for Payer: First Choice Health Commercial $285.32
Rate for Payer: Government Employees Health Association (GEHA) Commercial $285.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $174.20
Rate for Payer: HealthUtah PPO $300.34
Rate for Payer: Idaho Integrated Healthcare Commercial $291.33
Rate for Payer: Multiplan Medicare/VA $165.49
Rate for Payer: One Health Plan of WY PPO $294.33
Rate for Payer: PacificSource Commercial $270.31
Rate for Payer: PHCS PPO $294.33
Rate for Payer: Three Rivers PPO $225.26
Rate for Payer: TriWest Veterans Administration $174.20
Rate for Payer: United Healthcare Commercial $261.30
Rate for Payer: United Healthcare Medicare $174.20
Rate for Payer: WINHealth Partners Commercial $294.33
Rate for Payer: Wise Provider Network Commercial $285.32
Service Code HCPCS J7325
Hospital Revenue Code 636
Min. Negotiated Rate $188.31
Max. Negotiated Rate $300.34
Rate for Payer: Aetna of WY Commercial/Medical Rental $294.33
Rate for Payer: Altius Auto/Workers Compensation $288.33
Rate for Payer: Altius Commercial $288.33
Rate for Payer: Beech Street Commercial $294.33
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $246.58
Rate for Payer: Cash Price $210.24
Rate for Payer: ChoiceCare Network Commercial $291.33
Rate for Payer: Cigna of WY Commercial $294.33
Rate for Payer: Entrust Commercial $285.32
Rate for Payer: First Choice Health Commercial $285.32
Rate for Payer: Government Employees Health Association (GEHA) Commercial $285.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $198.22
Rate for Payer: HealthUtah PPO $300.34
Rate for Payer: Idaho Integrated Healthcare Commercial $291.33
Rate for Payer: Multiplan Medicare/VA $188.31
Rate for Payer: One Health Plan of WY PPO $294.33
Rate for Payer: PacificSource Commercial $270.31
Rate for Payer: PHCS PPO $294.33
Rate for Payer: Three Rivers PPO $225.26
Rate for Payer: TriWest Veterans Administration $198.22
Rate for Payer: United Healthcare Commercial $261.30
Rate for Payer: United Healthcare Medicare $198.22
Rate for Payer: WINHealth Partners Commercial $285.32
Rate for Payer: Wise Provider Network Commercial $285.32
Service Code HCPCS J7325
Hospital Revenue Code 636
Min. Negotiated Rate $224.09
Max. Negotiated Rate $357.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $350.25
Rate for Payer: Altius Auto/Workers Compensation $343.10
Rate for Payer: Altius Commercial $343.10
Rate for Payer: Beech Street Commercial $350.25
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $293.43
Rate for Payer: Cash Price $250.18
Rate for Payer: ChoiceCare Network Commercial $346.68
Rate for Payer: Cigna of WY Commercial $350.25
Rate for Payer: Entrust Commercial $339.53
Rate for Payer: First Choice Health Commercial $339.53
Rate for Payer: Government Employees Health Association (GEHA) Commercial $339.53
Rate for Payer: Government Employees Health Association (GEHA) Medicare $235.88
Rate for Payer: HealthUtah PPO $357.40
Rate for Payer: Idaho Integrated Healthcare Commercial $346.68
Rate for Payer: Multiplan Medicare/VA $224.09
Rate for Payer: One Health Plan of WY PPO $350.25
Rate for Payer: PacificSource Commercial $321.66
Rate for Payer: PHCS PPO $350.25
Rate for Payer: Three Rivers PPO $268.05
Rate for Payer: TriWest Veterans Administration $235.88
Rate for Payer: United Healthcare Commercial $310.94
Rate for Payer: United Healthcare Medicare $235.88
Rate for Payer: WINHealth Partners Commercial $339.53
Rate for Payer: Wise Provider Network Commercial $339.53
Service Code HCPCS J7325
Hospital Revenue Code 636
Min. Negotiated Rate $196.93
Max. Negotiated Rate $357.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $350.25
Rate for Payer: Aetna of WY Medicare $235.88
Rate for Payer: Altius Auto/Workers Compensation $343.10
Rate for Payer: Altius Commercial $343.10
Rate for Payer: Beech Street Commercial $350.25
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $293.43
Rate for Payer: Cash Price $250.18
Rate for Payer: ChoiceCare Network Commercial $346.68
Rate for Payer: Cigna of WY Commercial $350.25
Rate for Payer: Entrust Commercial $339.53
Rate for Payer: First Choice Health Commercial $339.53
Rate for Payer: Government Employees Health Association (GEHA) Commercial $339.53
Rate for Payer: Government Employees Health Association (GEHA) Medicare $207.29
Rate for Payer: HealthUtah PPO $357.40
Rate for Payer: Idaho Integrated Healthcare Commercial $346.68
Rate for Payer: Multiplan Medicare/VA $196.93
Rate for Payer: One Health Plan of WY PPO $350.25
Rate for Payer: PacificSource Commercial $321.66
Rate for Payer: PHCS PPO $350.25
Rate for Payer: Three Rivers PPO $268.05
Rate for Payer: TriWest Veterans Administration $207.29
Rate for Payer: United Healthcare Commercial $310.94
Rate for Payer: United Healthcare Medicare $207.29
Rate for Payer: WINHealth Partners Commercial $350.25
Rate for Payer: Wise Provider Network Commercial $339.53
Service Code HCPCS 56442
Hospital Charge Code 56442
Min. Negotiated Rate $38.93
Max. Negotiated Rate $1,638.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,605.24
Rate for Payer: Aetna of WY Medicare $45.80
Rate for Payer: Beech Street Commercial $1,556.10
Rate for Payer: Cash Price $1,146.60
Rate for Payer: Cash Price $1,146.60
Rate for Payer: ChoiceCare Network Commercial $1,588.86
Rate for Payer: Cigna of WY Commercial $1,605.24
Rate for Payer: First Choice Health Commercial $1,474.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,556.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $45.80
Rate for Payer: HealthUtah PPO $1,638.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,588.86
Rate for Payer: Multiplan Medicare/VA $38.93
Rate for Payer: One Health Plan of WY PPO $1,605.24
Rate for Payer: PacificSource Commercial $1,474.20
Rate for Payer: PHCS PPO $1,556.10
Rate for Payer: Three Rivers PPO $1,228.50
Rate for Payer: TriWest Veterans Administration $45.80
Rate for Payer: United Healthcare Commercial $1,425.06
Rate for Payer: United Healthcare Medicare $45.80
Rate for Payer: WINHealth Partners Commercial $1,392.30
Service Code HCPCS 59350
Hospital Charge Code 59350
Min. Negotiated Rate $221.64
Max. Negotiated Rate $676.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $662.48
Rate for Payer: Aetna of WY Medicare $260.75
Rate for Payer: Beech Street Commercial $642.20
Rate for Payer: Cash Price $473.20
Rate for Payer: Cash Price $473.20
Rate for Payer: ChoiceCare Network Commercial $655.72
Rate for Payer: Cigna of WY Commercial $662.48
Rate for Payer: First Choice Health Commercial $608.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $642.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $260.75
Rate for Payer: HealthUtah PPO $676.00
Rate for Payer: Idaho Integrated Healthcare Commercial $655.72
Rate for Payer: Multiplan Medicare/VA $221.64
Rate for Payer: One Health Plan of WY PPO $662.48
Rate for Payer: PacificSource Commercial $608.40
Rate for Payer: PHCS PPO $642.20
Rate for Payer: Three Rivers PPO $507.00
Rate for Payer: TriWest Veterans Administration $260.75
Rate for Payer: United Healthcare Commercial $588.12
Rate for Payer: United Healthcare Medicare $260.75
Rate for Payer: WINHealth Partners Commercial $574.60
Service Code HCPCS 58565
Hospital Charge Code 58565
Min. Negotiated Rate $376.41
Max. Negotiated Rate $2,321.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,274.58
Rate for Payer: Aetna of WY Medicare $442.84
Rate for Payer: Beech Street Commercial $2,204.95
Rate for Payer: Cash Price $1,624.70
Rate for Payer: Cash Price $1,624.70
Rate for Payer: ChoiceCare Network Commercial $2,251.37
Rate for Payer: Cigna of WY Commercial $2,274.58
Rate for Payer: First Choice Health Commercial $2,088.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,204.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $442.84
Rate for Payer: HealthUtah PPO $2,321.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,251.37
Rate for Payer: Multiplan Medicare/VA $376.41
Rate for Payer: One Health Plan of WY PPO $2,274.58
Rate for Payer: PacificSource Commercial $2,088.90
Rate for Payer: PHCS PPO $2,204.95
Rate for Payer: Three Rivers PPO $1,740.75
Rate for Payer: TriWest Veterans Administration $442.84
Rate for Payer: United Healthcare Commercial $2,019.27
Rate for Payer: United Healthcare Medicare $442.84
Rate for Payer: WINHealth Partners Commercial $1,972.85
Service Code HCPCS 58558
Hospital Charge Code 58558
Min. Negotiated Rate $187.44
Max. Negotiated Rate $4,324.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,237.52
Rate for Payer: Aetna of WY Medicare $220.52
Rate for Payer: Beech Street Commercial $4,107.80
Rate for Payer: Cash Price $3,026.80
Rate for Payer: Cash Price $3,026.80
Rate for Payer: ChoiceCare Network Commercial $4,194.28
Rate for Payer: Cigna of WY Commercial $4,237.52
Rate for Payer: First Choice Health Commercial $3,891.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,107.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $220.52
Rate for Payer: HealthUtah PPO $4,324.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,194.28
Rate for Payer: Multiplan Medicare/VA $187.44
Rate for Payer: One Health Plan of WY PPO $4,237.52
Rate for Payer: PacificSource Commercial $3,891.60
Rate for Payer: PHCS PPO $4,107.80
Rate for Payer: Three Rivers PPO $3,243.00
Rate for Payer: TriWest Veterans Administration $220.52
Rate for Payer: United Healthcare Commercial $3,761.88
Rate for Payer: United Healthcare Medicare $220.52
Rate for Payer: WINHealth Partners Commercial $3,675.40
Service Code HCPCS 58555
Hospital Charge Code 58555
Min. Negotiated Rate $122.88
Max. Negotiated Rate $2,821.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,764.58
Rate for Payer: Aetna of WY Medicare $144.57
Rate for Payer: Beech Street Commercial $2,679.95
Rate for Payer: Cash Price $1,974.70
Rate for Payer: Cash Price $1,974.70
Rate for Payer: ChoiceCare Network Commercial $2,736.37
Rate for Payer: Cigna of WY Commercial $2,764.58
Rate for Payer: First Choice Health Commercial $2,538.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,679.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $144.57
Rate for Payer: HealthUtah PPO $2,821.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,736.37
Rate for Payer: Multiplan Medicare/VA $122.88
Rate for Payer: One Health Plan of WY PPO $2,764.58
Rate for Payer: PacificSource Commercial $2,538.90
Rate for Payer: PHCS PPO $2,679.95
Rate for Payer: Three Rivers PPO $2,115.75
Rate for Payer: TriWest Veterans Administration $144.57
Rate for Payer: United Healthcare Commercial $2,454.27
Rate for Payer: United Healthcare Medicare $144.57
Rate for Payer: WINHealth Partners Commercial $2,397.85
Service Code HCPCS 58560
Hospital Charge Code 58560
Min. Negotiated Rate $253.11
Max. Negotiated Rate $1,316.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,289.68
Rate for Payer: Aetna of WY Medicare $297.78
Rate for Payer: Beech Street Commercial $1,250.20
Rate for Payer: Cash Price $921.20
Rate for Payer: Cash Price $921.20
Rate for Payer: ChoiceCare Network Commercial $1,276.52
Rate for Payer: Cigna of WY Commercial $1,289.68
Rate for Payer: First Choice Health Commercial $1,184.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,250.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $297.78
Rate for Payer: HealthUtah PPO $1,316.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,276.52
Rate for Payer: Multiplan Medicare/VA $253.11
Rate for Payer: One Health Plan of WY PPO $1,289.68
Rate for Payer: PacificSource Commercial $1,184.40
Rate for Payer: PHCS PPO $1,250.20
Rate for Payer: Three Rivers PPO $987.00
Rate for Payer: TriWest Veterans Administration $297.78
Rate for Payer: United Healthcare Commercial $1,144.92
Rate for Payer: United Healthcare Medicare $297.78
Rate for Payer: WINHealth Partners Commercial $1,118.60
Service Code HCPCS 58563
Hospital Charge Code 58563
Min. Negotiated Rate $199.12
Max. Negotiated Rate $4,255.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,169.90
Rate for Payer: Aetna of WY Medicare $234.26
Rate for Payer: Beech Street Commercial $4,042.25
Rate for Payer: Cash Price $2,978.50
Rate for Payer: Cash Price $2,978.50
Rate for Payer: ChoiceCare Network Commercial $4,127.35
Rate for Payer: Cigna of WY Commercial $4,169.90
Rate for Payer: First Choice Health Commercial $3,829.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,042.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $234.26
Rate for Payer: HealthUtah PPO $4,255.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,127.35
Rate for Payer: Multiplan Medicare/VA $199.12
Rate for Payer: One Health Plan of WY PPO $4,169.90
Rate for Payer: PacificSource Commercial $3,829.50
Rate for Payer: PHCS PPO $4,042.25
Rate for Payer: Three Rivers PPO $3,191.25
Rate for Payer: TriWest Veterans Administration $234.26
Rate for Payer: United Healthcare Commercial $3,701.85
Rate for Payer: United Healthcare Medicare $234.26
Rate for Payer: WINHealth Partners Commercial $3,616.75