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Service Code HCPCS 57456
Hospital Charge Code 5105745601
Hospital Revenue Code 510
Min. Negotiated Rate $56.20
Max. Negotiated Rate $102.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $99.96
Rate for Payer: Aetna of WY Medicare $67.32
Rate for Payer: Altius Auto/Workers Compensation $97.92
Rate for Payer: Altius Commercial $97.92
Rate for Payer: Beech Street Commercial $99.96
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $83.74
Rate for Payer: Cash Price $71.40
Rate for Payer: ChoiceCare Network Commercial $98.94
Rate for Payer: Cigna of WY Commercial $99.96
Rate for Payer: Entrust Commercial $96.90
Rate for Payer: First Choice Health Commercial $96.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $96.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $59.16
Rate for Payer: HealthUtah PPO $102.00
Rate for Payer: Idaho Integrated Healthcare Commercial $98.94
Rate for Payer: Multiplan Medicare/VA $56.20
Rate for Payer: One Health Plan of WY PPO $99.96
Rate for Payer: PacificSource Commercial $91.80
Rate for Payer: PHCS PPO $99.96
Rate for Payer: Three Rivers PPO $76.50
Rate for Payer: TriWest Veterans Administration $59.16
Rate for Payer: United Healthcare Commercial $88.74
Rate for Payer: United Healthcare Medicare $59.16
Rate for Payer: WINHealth Partners Commercial $99.96
Rate for Payer: Wise Provider Network Commercial $96.90
Service Code HCPCS 57452
Hospital Charge Code 5105745201
Hospital Revenue Code 510
Min. Negotiated Rate $50.69
Max. Negotiated Rate $92.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $90.16
Rate for Payer: Aetna of WY Medicare $60.72
Rate for Payer: Altius Auto/Workers Compensation $88.32
Rate for Payer: Altius Commercial $88.32
Rate for Payer: Beech Street Commercial $90.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $75.53
Rate for Payer: Cash Price $64.40
Rate for Payer: ChoiceCare Network Commercial $89.24
Rate for Payer: Cigna of WY Commercial $90.16
Rate for Payer: Entrust Commercial $87.40
Rate for Payer: First Choice Health Commercial $87.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $87.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $53.36
Rate for Payer: HealthUtah PPO $92.00
Rate for Payer: Idaho Integrated Healthcare Commercial $89.24
Rate for Payer: Multiplan Medicare/VA $50.69
Rate for Payer: One Health Plan of WY PPO $90.16
Rate for Payer: PacificSource Commercial $82.80
Rate for Payer: PHCS PPO $90.16
Rate for Payer: Three Rivers PPO $69.00
Rate for Payer: TriWest Veterans Administration $53.36
Rate for Payer: United Healthcare Commercial $80.04
Rate for Payer: United Healthcare Medicare $53.36
Rate for Payer: WINHealth Partners Commercial $90.16
Rate for Payer: Wise Provider Network Commercial $87.40
Service Code HCPCS 57452
Hospital Charge Code 5105745201
Hospital Revenue Code 510
Min. Negotiated Rate $57.68
Max. Negotiated Rate $92.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $90.16
Rate for Payer: Altius Auto/Workers Compensation $88.32
Rate for Payer: Altius Commercial $88.32
Rate for Payer: Beech Street Commercial $90.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $75.53
Rate for Payer: Cash Price $64.40
Rate for Payer: ChoiceCare Network Commercial $89.24
Rate for Payer: Cigna of WY Commercial $90.16
Rate for Payer: Entrust Commercial $87.40
Rate for Payer: First Choice Health Commercial $87.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $87.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $60.72
Rate for Payer: HealthUtah PPO $92.00
Rate for Payer: Idaho Integrated Healthcare Commercial $89.24
Rate for Payer: Multiplan Medicare/VA $57.68
Rate for Payer: One Health Plan of WY PPO $90.16
Rate for Payer: PacificSource Commercial $82.80
Rate for Payer: PHCS PPO $90.16
Rate for Payer: Three Rivers PPO $69.00
Rate for Payer: TriWest Veterans Administration $60.72
Rate for Payer: United Healthcare Commercial $80.04
Rate for Payer: United Healthcare Medicare $60.72
Rate for Payer: WINHealth Partners Commercial $87.40
Rate for Payer: Wise Provider Network Commercial $87.40
Service Code HCPCS 57455
Hospital Charge Code 5105745501
Hospital Revenue Code 510
Min. Negotiated Rate $61.16
Max. Negotiated Rate $111.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $108.78
Rate for Payer: Aetna of WY Medicare $73.26
Rate for Payer: Altius Auto/Workers Compensation $106.56
Rate for Payer: Altius Commercial $106.56
Rate for Payer: Beech Street Commercial $108.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $91.13
Rate for Payer: Cash Price $77.70
Rate for Payer: ChoiceCare Network Commercial $107.67
Rate for Payer: Cigna of WY Commercial $108.78
Rate for Payer: Entrust Commercial $105.45
Rate for Payer: First Choice Health Commercial $105.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $105.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $64.38
Rate for Payer: HealthUtah PPO $111.00
Rate for Payer: Idaho Integrated Healthcare Commercial $107.67
Rate for Payer: Multiplan Medicare/VA $61.16
Rate for Payer: One Health Plan of WY PPO $108.78
Rate for Payer: PacificSource Commercial $99.90
Rate for Payer: PHCS PPO $108.78
Rate for Payer: Three Rivers PPO $83.25
Rate for Payer: TriWest Veterans Administration $64.38
Rate for Payer: United Healthcare Commercial $96.57
Rate for Payer: United Healthcare Medicare $64.38
Rate for Payer: WINHealth Partners Commercial $108.78
Rate for Payer: Wise Provider Network Commercial $105.45
Service Code HCPCS 57455
Hospital Charge Code 5105745501
Hospital Revenue Code 510
Min. Negotiated Rate $69.60
Max. Negotiated Rate $111.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $108.78
Rate for Payer: Altius Auto/Workers Compensation $106.56
Rate for Payer: Altius Commercial $106.56
Rate for Payer: Beech Street Commercial $108.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $91.13
Rate for Payer: Cash Price $77.70
Rate for Payer: ChoiceCare Network Commercial $107.67
Rate for Payer: Cigna of WY Commercial $108.78
Rate for Payer: Entrust Commercial $105.45
Rate for Payer: First Choice Health Commercial $105.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $105.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $73.26
Rate for Payer: HealthUtah PPO $111.00
Rate for Payer: Idaho Integrated Healthcare Commercial $107.67
Rate for Payer: Multiplan Medicare/VA $69.60
Rate for Payer: One Health Plan of WY PPO $108.78
Rate for Payer: PacificSource Commercial $99.90
Rate for Payer: PHCS PPO $108.78
Rate for Payer: Three Rivers PPO $83.25
Rate for Payer: TriWest Veterans Administration $73.26
Rate for Payer: United Healthcare Commercial $96.57
Rate for Payer: United Healthcare Medicare $73.26
Rate for Payer: WINHealth Partners Commercial $105.45
Rate for Payer: Wise Provider Network Commercial $105.45
Service Code HCPCS 57461
Hospital Charge Code 5105746101
Hospital Revenue Code 510
Min. Negotiated Rate $117.25
Max. Negotiated Rate $187.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $183.26
Rate for Payer: Altius Auto/Workers Compensation $179.52
Rate for Payer: Altius Commercial $179.52
Rate for Payer: Beech Street Commercial $183.26
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $153.53
Rate for Payer: Cash Price $130.90
Rate for Payer: ChoiceCare Network Commercial $181.39
Rate for Payer: Cigna of WY Commercial $183.26
Rate for Payer: Entrust Commercial $177.65
Rate for Payer: First Choice Health Commercial $177.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $177.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $123.42
Rate for Payer: HealthUtah PPO $187.00
Rate for Payer: Idaho Integrated Healthcare Commercial $181.39
Rate for Payer: Multiplan Medicare/VA $117.25
Rate for Payer: One Health Plan of WY PPO $183.26
Rate for Payer: PacificSource Commercial $168.30
Rate for Payer: PHCS PPO $183.26
Rate for Payer: Three Rivers PPO $140.25
Rate for Payer: TriWest Veterans Administration $123.42
Rate for Payer: United Healthcare Commercial $162.69
Rate for Payer: United Healthcare Medicare $123.42
Rate for Payer: WINHealth Partners Commercial $177.65
Rate for Payer: Wise Provider Network Commercial $177.65
Service Code HCPCS 57461
Hospital Charge Code 5105746101
Hospital Revenue Code 510
Min. Negotiated Rate $103.04
Max. Negotiated Rate $187.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $183.26
Rate for Payer: Aetna of WY Medicare $123.42
Rate for Payer: Altius Auto/Workers Compensation $179.52
Rate for Payer: Altius Commercial $179.52
Rate for Payer: Beech Street Commercial $183.26
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $153.53
Rate for Payer: Cash Price $130.90
Rate for Payer: ChoiceCare Network Commercial $181.39
Rate for Payer: Cigna of WY Commercial $183.26
Rate for Payer: Entrust Commercial $177.65
Rate for Payer: First Choice Health Commercial $177.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $177.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $108.46
Rate for Payer: HealthUtah PPO $187.00
Rate for Payer: Idaho Integrated Healthcare Commercial $181.39
Rate for Payer: Multiplan Medicare/VA $103.04
Rate for Payer: One Health Plan of WY PPO $183.26
Rate for Payer: PacificSource Commercial $168.30
Rate for Payer: PHCS PPO $183.26
Rate for Payer: Three Rivers PPO $140.25
Rate for Payer: TriWest Veterans Administration $108.46
Rate for Payer: United Healthcare Commercial $162.69
Rate for Payer: United Healthcare Medicare $108.46
Rate for Payer: WINHealth Partners Commercial $183.26
Rate for Payer: Wise Provider Network Commercial $177.65
Service Code HCPCS 57460
Hospital Charge Code 5105746001
Hospital Revenue Code 510
Min. Negotiated Rate $101.57
Max. Negotiated Rate $162.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $158.76
Rate for Payer: Altius Auto/Workers Compensation $155.52
Rate for Payer: Altius Commercial $155.52
Rate for Payer: Beech Street Commercial $158.76
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $133.00
Rate for Payer: Cash Price $113.40
Rate for Payer: ChoiceCare Network Commercial $157.14
Rate for Payer: Cigna of WY Commercial $158.76
Rate for Payer: Entrust Commercial $153.90
Rate for Payer: First Choice Health Commercial $153.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $153.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $106.92
Rate for Payer: HealthUtah PPO $162.00
Rate for Payer: Idaho Integrated Healthcare Commercial $157.14
Rate for Payer: Multiplan Medicare/VA $101.57
Rate for Payer: One Health Plan of WY PPO $158.76
Rate for Payer: PacificSource Commercial $145.80
Rate for Payer: PHCS PPO $158.76
Rate for Payer: Three Rivers PPO $121.50
Rate for Payer: TriWest Veterans Administration $106.92
Rate for Payer: United Healthcare Commercial $140.94
Rate for Payer: United Healthcare Medicare $106.92
Rate for Payer: WINHealth Partners Commercial $153.90
Rate for Payer: Wise Provider Network Commercial $153.90
Service Code HCPCS 57460
Hospital Charge Code 5105746001
Hospital Revenue Code 510
Min. Negotiated Rate $89.26
Max. Negotiated Rate $162.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $158.76
Rate for Payer: Aetna of WY Medicare $106.92
Rate for Payer: Altius Auto/Workers Compensation $155.52
Rate for Payer: Altius Commercial $155.52
Rate for Payer: Beech Street Commercial $158.76
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $133.00
Rate for Payer: Cash Price $113.40
Rate for Payer: ChoiceCare Network Commercial $157.14
Rate for Payer: Cigna of WY Commercial $158.76
Rate for Payer: Entrust Commercial $153.90
Rate for Payer: First Choice Health Commercial $153.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $153.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $93.96
Rate for Payer: HealthUtah PPO $162.00
Rate for Payer: Idaho Integrated Healthcare Commercial $157.14
Rate for Payer: Multiplan Medicare/VA $89.26
Rate for Payer: One Health Plan of WY PPO $158.76
Rate for Payer: PacificSource Commercial $145.80
Rate for Payer: PHCS PPO $158.76
Rate for Payer: Three Rivers PPO $121.50
Rate for Payer: TriWest Veterans Administration $93.96
Rate for Payer: United Healthcare Commercial $140.94
Rate for Payer: United Healthcare Medicare $93.96
Rate for Payer: WINHealth Partners Commercial $158.76
Rate for Payer: Wise Provider Network Commercial $153.90
Service Code HCPCS 57420
Hospital Charge Code 5105742001
Hospital Revenue Code 510
Min. Negotiated Rate $57.06
Max. Negotiated Rate $91.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $89.18
Rate for Payer: Altius Auto/Workers Compensation $87.36
Rate for Payer: Altius Commercial $87.36
Rate for Payer: Beech Street Commercial $89.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $74.71
Rate for Payer: Cash Price $63.70
Rate for Payer: ChoiceCare Network Commercial $88.27
Rate for Payer: Cigna of WY Commercial $89.18
Rate for Payer: Entrust Commercial $86.45
Rate for Payer: First Choice Health Commercial $86.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $86.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $60.06
Rate for Payer: HealthUtah PPO $91.00
Rate for Payer: Idaho Integrated Healthcare Commercial $88.27
Rate for Payer: Multiplan Medicare/VA $57.06
Rate for Payer: One Health Plan of WY PPO $89.18
Rate for Payer: PacificSource Commercial $81.90
Rate for Payer: PHCS PPO $89.18
Rate for Payer: Three Rivers PPO $68.25
Rate for Payer: TriWest Veterans Administration $60.06
Rate for Payer: United Healthcare Commercial $79.17
Rate for Payer: United Healthcare Medicare $60.06
Rate for Payer: WINHealth Partners Commercial $86.45
Rate for Payer: Wise Provider Network Commercial $86.45
Service Code HCPCS 57420
Hospital Charge Code 5105742001
Hospital Revenue Code 510
Min. Negotiated Rate $50.14
Max. Negotiated Rate $91.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $89.18
Rate for Payer: Aetna of WY Medicare $60.06
Rate for Payer: Altius Auto/Workers Compensation $87.36
Rate for Payer: Altius Commercial $87.36
Rate for Payer: Beech Street Commercial $89.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $74.71
Rate for Payer: Cash Price $63.70
Rate for Payer: ChoiceCare Network Commercial $88.27
Rate for Payer: Cigna of WY Commercial $89.18
Rate for Payer: Entrust Commercial $86.45
Rate for Payer: First Choice Health Commercial $86.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $86.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $52.78
Rate for Payer: HealthUtah PPO $91.00
Rate for Payer: Idaho Integrated Healthcare Commercial $88.27
Rate for Payer: Multiplan Medicare/VA $50.14
Rate for Payer: One Health Plan of WY PPO $89.18
Rate for Payer: PacificSource Commercial $81.90
Rate for Payer: PHCS PPO $89.18
Rate for Payer: Three Rivers PPO $68.25
Rate for Payer: TriWest Veterans Administration $52.78
Rate for Payer: United Healthcare Commercial $79.17
Rate for Payer: United Healthcare Medicare $52.78
Rate for Payer: WINHealth Partners Commercial $89.18
Rate for Payer: Wise Provider Network Commercial $86.45
Service Code HCPCS 57421
Hospital Charge Code 5105742101
Hospital Revenue Code 510
Min. Negotiated Rate $68.32
Max. Negotiated Rate $124.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $121.52
Rate for Payer: Aetna of WY Medicare $81.84
Rate for Payer: Altius Auto/Workers Compensation $119.04
Rate for Payer: Altius Commercial $119.04
Rate for Payer: Beech Street Commercial $121.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $101.80
Rate for Payer: Cash Price $86.80
Rate for Payer: ChoiceCare Network Commercial $120.28
Rate for Payer: Cigna of WY Commercial $121.52
Rate for Payer: Entrust Commercial $117.80
Rate for Payer: First Choice Health Commercial $117.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $117.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $71.92
Rate for Payer: HealthUtah PPO $124.00
Rate for Payer: Idaho Integrated Healthcare Commercial $120.28
Rate for Payer: Multiplan Medicare/VA $68.32
Rate for Payer: One Health Plan of WY PPO $121.52
Rate for Payer: PacificSource Commercial $111.60
Rate for Payer: PHCS PPO $121.52
Rate for Payer: Three Rivers PPO $93.00
Rate for Payer: TriWest Veterans Administration $71.92
Rate for Payer: United Healthcare Commercial $107.88
Rate for Payer: United Healthcare Medicare $71.92
Rate for Payer: WINHealth Partners Commercial $121.52
Rate for Payer: Wise Provider Network Commercial $117.80
Service Code HCPCS 57421
Hospital Charge Code 5105742101
Hospital Revenue Code 510
Min. Negotiated Rate $77.75
Max. Negotiated Rate $124.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $121.52
Rate for Payer: Altius Auto/Workers Compensation $119.04
Rate for Payer: Altius Commercial $119.04
Rate for Payer: Beech Street Commercial $121.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $101.80
Rate for Payer: Cash Price $86.80
Rate for Payer: ChoiceCare Network Commercial $120.28
Rate for Payer: Cigna of WY Commercial $121.52
Rate for Payer: Entrust Commercial $117.80
Rate for Payer: First Choice Health Commercial $117.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $117.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $81.84
Rate for Payer: HealthUtah PPO $124.00
Rate for Payer: Idaho Integrated Healthcare Commercial $120.28
Rate for Payer: Multiplan Medicare/VA $77.75
Rate for Payer: One Health Plan of WY PPO $121.52
Rate for Payer: PacificSource Commercial $111.60
Rate for Payer: PHCS PPO $121.52
Rate for Payer: Three Rivers PPO $93.00
Rate for Payer: TriWest Veterans Administration $81.84
Rate for Payer: United Healthcare Commercial $107.88
Rate for Payer: United Healthcare Medicare $81.84
Rate for Payer: WINHealth Partners Commercial $117.80
Rate for Payer: Wise Provider Network Commercial $117.80
Service Code HCPCS 85242
Hospital Charge Code 3058524201
Hospital Revenue Code 305
Min. Negotiated Rate $261.72
Max. Negotiated Rate $475.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $465.50
Rate for Payer: Aetna of WY Medicare $313.50
Rate for Payer: Altius Auto/Workers Compensation $456.00
Rate for Payer: Altius Commercial $456.00
Rate for Payer: Beech Street Commercial $465.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $389.98
Rate for Payer: Cash Price $332.50
Rate for Payer: ChoiceCare Network Commercial $460.75
Rate for Payer: Cigna of WY Commercial $465.50
Rate for Payer: Entrust Commercial $451.25
Rate for Payer: First Choice Health Commercial $451.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $451.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $275.50
Rate for Payer: HealthUtah PPO $475.00
Rate for Payer: Idaho Integrated Healthcare Commercial $460.75
Rate for Payer: Multiplan Medicare/VA $261.72
Rate for Payer: One Health Plan of WY PPO $465.50
Rate for Payer: PacificSource Commercial $427.50
Rate for Payer: PHCS PPO $465.50
Rate for Payer: Three Rivers PPO $356.25
Rate for Payer: TriWest Veterans Administration $275.50
Rate for Payer: United Healthcare Commercial $413.25
Rate for Payer: United Healthcare Medicare $275.50
Rate for Payer: WINHealth Partners Commercial $465.50
Rate for Payer: Wise Provider Network Commercial $451.25
Service Code HCPCS 85242
Hospital Charge Code 3058524201
Hospital Revenue Code 305
Min. Negotiated Rate $297.82
Max. Negotiated Rate $475.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $465.50
Rate for Payer: Altius Auto/Workers Compensation $456.00
Rate for Payer: Altius Commercial $456.00
Rate for Payer: Beech Street Commercial $465.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $389.98
Rate for Payer: Cash Price $332.50
Rate for Payer: ChoiceCare Network Commercial $460.75
Rate for Payer: Cigna of WY Commercial $465.50
Rate for Payer: Entrust Commercial $451.25
Rate for Payer: First Choice Health Commercial $451.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $451.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $313.50
Rate for Payer: HealthUtah PPO $475.00
Rate for Payer: Idaho Integrated Healthcare Commercial $460.75
Rate for Payer: Multiplan Medicare/VA $297.82
Rate for Payer: One Health Plan of WY PPO $465.50
Rate for Payer: PacificSource Commercial $427.50
Rate for Payer: PHCS PPO $465.50
Rate for Payer: Three Rivers PPO $356.25
Rate for Payer: TriWest Veterans Administration $313.50
Rate for Payer: United Healthcare Commercial $413.25
Rate for Payer: United Healthcare Medicare $313.50
Rate for Payer: WINHealth Partners Commercial $451.25
Rate for Payer: Wise Provider Network Commercial $451.25
Service Code HCPCS 86923
Hospital Charge Code 3008692301
Hospital Revenue Code 300
Min. Negotiated Rate $329.18
Max. Negotiated Rate $525.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $514.50
Rate for Payer: Altius Auto/Workers Compensation $504.00
Rate for Payer: Altius Commercial $504.00
Rate for Payer: Beech Street Commercial $514.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $431.02
Rate for Payer: Cash Price $367.50
Rate for Payer: ChoiceCare Network Commercial $509.25
Rate for Payer: Cigna of WY Commercial $514.50
Rate for Payer: Entrust Commercial $498.75
Rate for Payer: First Choice Health Commercial $498.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $498.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $346.50
Rate for Payer: HealthUtah PPO $525.00
Rate for Payer: Idaho Integrated Healthcare Commercial $509.25
Rate for Payer: Multiplan Medicare/VA $329.18
Rate for Payer: One Health Plan of WY PPO $514.50
Rate for Payer: PacificSource Commercial $472.50
Rate for Payer: PHCS PPO $514.50
Rate for Payer: Three Rivers PPO $393.75
Rate for Payer: TriWest Veterans Administration $346.50
Rate for Payer: United Healthcare Commercial $456.75
Rate for Payer: United Healthcare Medicare $346.50
Rate for Payer: WINHealth Partners Commercial $498.75
Rate for Payer: Wise Provider Network Commercial $498.75
Service Code HCPCS 86923
Hospital Charge Code 3008692301
Hospital Revenue Code 300
Min. Negotiated Rate $289.28
Max. Negotiated Rate $525.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $514.50
Rate for Payer: Aetna of WY Medicare $346.50
Rate for Payer: Altius Auto/Workers Compensation $504.00
Rate for Payer: Altius Commercial $504.00
Rate for Payer: Beech Street Commercial $514.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $431.02
Rate for Payer: Cash Price $367.50
Rate for Payer: ChoiceCare Network Commercial $509.25
Rate for Payer: Cigna of WY Commercial $514.50
Rate for Payer: Entrust Commercial $498.75
Rate for Payer: First Choice Health Commercial $498.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $498.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $304.50
Rate for Payer: HealthUtah PPO $525.00
Rate for Payer: Idaho Integrated Healthcare Commercial $509.25
Rate for Payer: Multiplan Medicare/VA $289.28
Rate for Payer: One Health Plan of WY PPO $514.50
Rate for Payer: PacificSource Commercial $472.50
Rate for Payer: PHCS PPO $514.50
Rate for Payer: Three Rivers PPO $393.75
Rate for Payer: TriWest Veterans Administration $304.50
Rate for Payer: United Healthcare Commercial $456.75
Rate for Payer: United Healthcare Medicare $304.50
Rate for Payer: WINHealth Partners Commercial $514.50
Rate for Payer: Wise Provider Network Commercial $498.75
Service Code HCPCS 86922
Hospital Charge Code 3008692201
Hospital Revenue Code 300
Min. Negotiated Rate $369.93
Max. Negotiated Rate $590.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $578.20
Rate for Payer: Altius Auto/Workers Compensation $566.40
Rate for Payer: Altius Commercial $566.40
Rate for Payer: Beech Street Commercial $578.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $484.39
Rate for Payer: Cash Price $413.00
Rate for Payer: ChoiceCare Network Commercial $572.30
Rate for Payer: Cigna of WY Commercial $578.20
Rate for Payer: Entrust Commercial $560.50
Rate for Payer: First Choice Health Commercial $560.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $560.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $389.40
Rate for Payer: HealthUtah PPO $590.00
Rate for Payer: Idaho Integrated Healthcare Commercial $572.30
Rate for Payer: Multiplan Medicare/VA $369.93
Rate for Payer: One Health Plan of WY PPO $578.20
Rate for Payer: PacificSource Commercial $531.00
Rate for Payer: PHCS PPO $578.20
Rate for Payer: Three Rivers PPO $442.50
Rate for Payer: TriWest Veterans Administration $389.40
Rate for Payer: United Healthcare Commercial $513.30
Rate for Payer: United Healthcare Medicare $389.40
Rate for Payer: WINHealth Partners Commercial $560.50
Rate for Payer: Wise Provider Network Commercial $560.50
Service Code HCPCS 86922
Hospital Charge Code 3008692201
Hospital Revenue Code 300
Min. Negotiated Rate $325.09
Max. Negotiated Rate $590.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $578.20
Rate for Payer: Aetna of WY Medicare $389.40
Rate for Payer: Altius Auto/Workers Compensation $566.40
Rate for Payer: Altius Commercial $566.40
Rate for Payer: Beech Street Commercial $578.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $484.39
Rate for Payer: Cash Price $413.00
Rate for Payer: ChoiceCare Network Commercial $572.30
Rate for Payer: Cigna of WY Commercial $578.20
Rate for Payer: Entrust Commercial $560.50
Rate for Payer: First Choice Health Commercial $560.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $560.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $342.20
Rate for Payer: HealthUtah PPO $590.00
Rate for Payer: Idaho Integrated Healthcare Commercial $572.30
Rate for Payer: Multiplan Medicare/VA $325.09
Rate for Payer: One Health Plan of WY PPO $578.20
Rate for Payer: PacificSource Commercial $531.00
Rate for Payer: PHCS PPO $578.20
Rate for Payer: Three Rivers PPO $442.50
Rate for Payer: TriWest Veterans Administration $342.20
Rate for Payer: United Healthcare Commercial $513.30
Rate for Payer: United Healthcare Medicare $342.20
Rate for Payer: WINHealth Partners Commercial $578.20
Rate for Payer: Wise Provider Network Commercial $560.50
Service Code HCPCS 86160
Hospital Charge Code 3028616008
Hospital Revenue Code 302
Min. Negotiated Rate $100.83
Max. Negotiated Rate $183.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $179.34
Rate for Payer: Aetna of WY Medicare $120.78
Rate for Payer: Altius Auto/Workers Compensation $175.68
Rate for Payer: Altius Commercial $175.68
Rate for Payer: Beech Street Commercial $179.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $150.24
Rate for Payer: Cash Price $128.10
Rate for Payer: ChoiceCare Network Commercial $177.51
Rate for Payer: Cigna of WY Commercial $179.34
Rate for Payer: Entrust Commercial $173.85
Rate for Payer: First Choice Health Commercial $173.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $173.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $106.14
Rate for Payer: HealthUtah PPO $183.00
Rate for Payer: Idaho Integrated Healthcare Commercial $177.51
Rate for Payer: Multiplan Medicare/VA $100.83
Rate for Payer: One Health Plan of WY PPO $179.34
Rate for Payer: PacificSource Commercial $164.70
Rate for Payer: PHCS PPO $179.34
Rate for Payer: Three Rivers PPO $137.25
Rate for Payer: TriWest Veterans Administration $106.14
Rate for Payer: United Healthcare Commercial $159.21
Rate for Payer: United Healthcare Medicare $106.14
Rate for Payer: WINHealth Partners Commercial $179.34
Rate for Payer: Wise Provider Network Commercial $173.85
Service Code HCPCS 86160
Hospital Charge Code 3028616008
Hospital Revenue Code 302
Min. Negotiated Rate $114.74
Max. Negotiated Rate $183.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $179.34
Rate for Payer: Altius Auto/Workers Compensation $175.68
Rate for Payer: Altius Commercial $175.68
Rate for Payer: Beech Street Commercial $179.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $150.24
Rate for Payer: Cash Price $128.10
Rate for Payer: ChoiceCare Network Commercial $177.51
Rate for Payer: Cigna of WY Commercial $179.34
Rate for Payer: Entrust Commercial $173.85
Rate for Payer: First Choice Health Commercial $173.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $173.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $120.78
Rate for Payer: HealthUtah PPO $183.00
Rate for Payer: Idaho Integrated Healthcare Commercial $177.51
Rate for Payer: Multiplan Medicare/VA $114.74
Rate for Payer: One Health Plan of WY PPO $179.34
Rate for Payer: PacificSource Commercial $164.70
Rate for Payer: PHCS PPO $179.34
Rate for Payer: Three Rivers PPO $137.25
Rate for Payer: TriWest Veterans Administration $120.78
Rate for Payer: United Healthcare Commercial $159.21
Rate for Payer: United Healthcare Medicare $120.78
Rate for Payer: WINHealth Partners Commercial $173.85
Rate for Payer: Wise Provider Network Commercial $173.85
Service Code HCPCS 86160
Hospital Charge Code 3028616003
Hospital Revenue Code 302
Min. Negotiated Rate $60.61
Max. Negotiated Rate $110.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $107.80
Rate for Payer: Aetna of WY Medicare $72.60
Rate for Payer: Altius Auto/Workers Compensation $105.60
Rate for Payer: Altius Commercial $105.60
Rate for Payer: Beech Street Commercial $107.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $90.31
Rate for Payer: Cash Price $77.00
Rate for Payer: ChoiceCare Network Commercial $106.70
Rate for Payer: Cigna of WY Commercial $107.80
Rate for Payer: Entrust Commercial $104.50
Rate for Payer: First Choice Health Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $63.80
Rate for Payer: HealthUtah PPO $110.00
Rate for Payer: Idaho Integrated Healthcare Commercial $106.70
Rate for Payer: Multiplan Medicare/VA $60.61
Rate for Payer: One Health Plan of WY PPO $107.80
Rate for Payer: PacificSource Commercial $99.00
Rate for Payer: PHCS PPO $107.80
Rate for Payer: Three Rivers PPO $82.50
Rate for Payer: TriWest Veterans Administration $63.80
Rate for Payer: United Healthcare Commercial $95.70
Rate for Payer: United Healthcare Medicare $63.80
Rate for Payer: WINHealth Partners Commercial $107.80
Rate for Payer: Wise Provider Network Commercial $104.50
Service Code HCPCS 86160
Hospital Charge Code 3028616003
Hospital Revenue Code 302
Min. Negotiated Rate $68.97
Max. Negotiated Rate $110.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $107.80
Rate for Payer: Altius Auto/Workers Compensation $105.60
Rate for Payer: Altius Commercial $105.60
Rate for Payer: Beech Street Commercial $107.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $90.31
Rate for Payer: Cash Price $77.00
Rate for Payer: ChoiceCare Network Commercial $106.70
Rate for Payer: Cigna of WY Commercial $107.80
Rate for Payer: Entrust Commercial $104.50
Rate for Payer: First Choice Health Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $104.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $72.60
Rate for Payer: HealthUtah PPO $110.00
Rate for Payer: Idaho Integrated Healthcare Commercial $106.70
Rate for Payer: Multiplan Medicare/VA $68.97
Rate for Payer: One Health Plan of WY PPO $107.80
Rate for Payer: PacificSource Commercial $99.00
Rate for Payer: PHCS PPO $107.80
Rate for Payer: Three Rivers PPO $82.50
Rate for Payer: TriWest Veterans Administration $72.60
Rate for Payer: United Healthcare Commercial $95.70
Rate for Payer: United Healthcare Medicare $72.60
Rate for Payer: WINHealth Partners Commercial $104.50
Rate for Payer: Wise Provider Network Commercial $104.50
Service Code HCPCS 86160
Hospital Charge Code 3028616002
Hospital Revenue Code 302
Min. Negotiated Rate $99.18
Max. Negotiated Rate $180.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $176.40
Rate for Payer: Aetna of WY Medicare $118.80
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 $104.40
Rate for Payer: HealthUtah PPO $180.00
Rate for Payer: Idaho Integrated Healthcare Commercial $174.60
Rate for Payer: Multiplan Medicare/VA $99.18
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 $104.40
Rate for Payer: United Healthcare Commercial $156.60
Rate for Payer: United Healthcare Medicare $104.40
Rate for Payer: WINHealth Partners Commercial $176.40
Rate for Payer: Wise Provider Network Commercial $171.00
Service Code HCPCS 86160
Hospital Charge Code 3028616002
Hospital Revenue Code 302
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