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Service Code HCPCS 26720
Hospital Charge Code 7612672001
Hospital Revenue Code 761
Min. Negotiated Rate $153.24
Max. Negotiated Rate $283.00
Rate for Payer: United Healthcare Commercial $270.26
Rate for Payer: Aetna of WY Commercial/Medical Rental $277.34
Rate for Payer: Aetna of WY Medicare $186.78
Rate for Payer: Altius Commercial $271.68
Rate for Payer: Beech Street Commercial $277.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $274.51
Rate for Payer: Cash Price $198.10
Rate for Payer: ChoiceCare Network Commercial $274.51
Rate for Payer: Cigna of WY Commercial $277.34
Rate for Payer: Entrust Commercial $268.85
Rate for Payer: First Choice Health Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $161.31
Rate for Payer: HealthUtah PPO $283.00
Rate for Payer: Idaho Integrated Healthcare Commercial $274.51
Rate for Payer: Multiplan Medicare/VA $153.24
Rate for Payer: One Health Plan of WY PPO $277.34
Rate for Payer: PacificSource Commercial $254.70
Rate for Payer: PHCS PPO $277.34
Rate for Payer: Three Rivers PPO $212.25
Rate for Payer: TriWest Veterans Administration $161.31
Rate for Payer: United Healthcare Medicare $161.31
Rate for Payer: WINHealth Partners Commercial $277.34
Rate for Payer: Wise Provider Network Commercial $268.85
Service Code HCPCS 26725
Hospital Charge Code 7612672501
Hospital Revenue Code 761
Min. Negotiated Rate $164.00
Max. Negotiated Rate $283.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $277.34
Rate for Payer: Aetna of WY Medicare $181.12
Rate for Payer: Altius Commercial $271.68
Rate for Payer: Beech Street Commercial $277.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $274.51
Rate for Payer: Cash Price $198.10
Rate for Payer: ChoiceCare Network Commercial $274.51
Rate for Payer: Cigna of WY Commercial $277.34
Rate for Payer: Entrust Commercial $268.85
Rate for Payer: First Choice Health Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $172.63
Rate for Payer: HealthUtah PPO $283.00
Rate for Payer: Idaho Integrated Healthcare Commercial $274.51
Rate for Payer: Multiplan Medicare/VA $164.00
Rate for Payer: One Health Plan of WY PPO $277.34
Rate for Payer: PacificSource Commercial $254.70
Rate for Payer: PHCS PPO $277.34
Rate for Payer: Three Rivers PPO $212.25
Rate for Payer: TriWest Veterans Administration $172.63
Rate for Payer: United Healthcare Commercial $270.26
Rate for Payer: United Healthcare Medicare $172.63
Rate for Payer: WINHealth Partners Commercial $268.85
Rate for Payer: Wise Provider Network Commercial $268.85
Service Code HCPCS 26725
Hospital Charge Code 7612672501
Hospital Revenue Code 761
Min. Negotiated Rate $153.24
Max. Negotiated Rate $283.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $277.34
Rate for Payer: Aetna of WY Medicare $186.78
Rate for Payer: Altius Commercial $271.68
Rate for Payer: Beech Street Commercial $277.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $274.51
Rate for Payer: Cash Price $198.10
Rate for Payer: ChoiceCare Network Commercial $274.51
Rate for Payer: Cigna of WY Commercial $277.34
Rate for Payer: Entrust Commercial $268.85
Rate for Payer: First Choice Health Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $161.31
Rate for Payer: HealthUtah PPO $283.00
Rate for Payer: Idaho Integrated Healthcare Commercial $274.51
Rate for Payer: Multiplan Medicare/VA $153.24
Rate for Payer: One Health Plan of WY PPO $277.34
Rate for Payer: PacificSource Commercial $254.70
Rate for Payer: PHCS PPO $277.34
Rate for Payer: Three Rivers PPO $212.25
Rate for Payer: TriWest Veterans Administration $161.31
Rate for Payer: United Healthcare Commercial $270.26
Rate for Payer: United Healthcare Medicare $161.31
Rate for Payer: WINHealth Partners Commercial $277.34
Rate for Payer: Wise Provider Network Commercial $268.85
Service Code HCPCS 12020
Hospital Charge Code 7611202001
Hospital Revenue Code 761
Min. Negotiated Rate $164.00
Max. Negotiated Rate $283.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $277.34
Rate for Payer: Aetna of WY Medicare $181.12
Rate for Payer: Altius Commercial $271.68
Rate for Payer: Beech Street Commercial $277.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $274.51
Rate for Payer: Cash Price $198.10
Rate for Payer: ChoiceCare Network Commercial $274.51
Rate for Payer: Cigna of WY Commercial $277.34
Rate for Payer: Entrust Commercial $268.85
Rate for Payer: First Choice Health Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $172.63
Rate for Payer: HealthUtah PPO $283.00
Rate for Payer: Idaho Integrated Healthcare Commercial $274.51
Rate for Payer: Multiplan Medicare/VA $164.00
Rate for Payer: One Health Plan of WY PPO $277.34
Rate for Payer: PacificSource Commercial $254.70
Rate for Payer: PHCS PPO $277.34
Rate for Payer: Three Rivers PPO $212.25
Rate for Payer: TriWest Veterans Administration $172.63
Rate for Payer: United Healthcare Commercial $270.26
Rate for Payer: United Healthcare Medicare $172.63
Rate for Payer: WINHealth Partners Commercial $268.85
Rate for Payer: Wise Provider Network Commercial $268.85
Service Code HCPCS 12020
Hospital Charge Code 7611202001
Hospital Revenue Code 761
Min. Negotiated Rate $153.24
Max. Negotiated Rate $283.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $277.34
Rate for Payer: Aetna of WY Medicare $186.78
Rate for Payer: Altius Commercial $271.68
Rate for Payer: Beech Street Commercial $277.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $274.51
Rate for Payer: Cash Price $198.10
Rate for Payer: ChoiceCare Network Commercial $274.51
Rate for Payer: Cigna of WY Commercial $277.34
Rate for Payer: Entrust Commercial $268.85
Rate for Payer: First Choice Health Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $161.31
Rate for Payer: HealthUtah PPO $283.00
Rate for Payer: Idaho Integrated Healthcare Commercial $274.51
Rate for Payer: Multiplan Medicare/VA $153.24
Rate for Payer: One Health Plan of WY PPO $277.34
Rate for Payer: PacificSource Commercial $254.70
Rate for Payer: PHCS PPO $277.34
Rate for Payer: Three Rivers PPO $212.25
Rate for Payer: TriWest Veterans Administration $161.31
Rate for Payer: United Healthcare Commercial $270.26
Rate for Payer: United Healthcare Medicare $161.31
Rate for Payer: WINHealth Partners Commercial $277.34
Rate for Payer: Wise Provider Network Commercial $268.85
Service Code HCPCS 12021
Hospital Charge Code 5101202101
Hospital Revenue Code 510
Min. Negotiated Rate $63.17
Max. Negotiated Rate $109.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $106.82
Rate for Payer: Aetna of WY Medicare $69.76
Rate for Payer: Altius Commercial $104.64
Rate for Payer: Beech Street Commercial $106.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $105.73
Rate for Payer: Cash Price $76.30
Rate for Payer: ChoiceCare Network Commercial $105.73
Rate for Payer: Cigna of WY Commercial $106.82
Rate for Payer: Entrust Commercial $103.55
Rate for Payer: First Choice Health Commercial $103.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $103.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.49
Rate for Payer: HealthUtah PPO $109.00
Rate for Payer: Idaho Integrated Healthcare Commercial $105.73
Rate for Payer: Multiplan Medicare/VA $63.17
Rate for Payer: One Health Plan of WY PPO $106.82
Rate for Payer: PacificSource Commercial $98.10
Rate for Payer: PHCS PPO $106.82
Rate for Payer: Three Rivers PPO $81.75
Rate for Payer: TriWest Veterans Administration $66.49
Rate for Payer: United Healthcare Commercial $104.10
Rate for Payer: United Healthcare Medicare $66.49
Rate for Payer: WINHealth Partners Commercial $103.55
Rate for Payer: Wise Provider Network Commercial $103.55
Service Code HCPCS 12021
Hospital Charge Code 5101202101
Hospital Revenue Code 510
Min. Negotiated Rate $59.02
Max. Negotiated Rate $109.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $106.82
Rate for Payer: Aetna of WY Medicare $71.94
Rate for Payer: Altius Commercial $104.64
Rate for Payer: Beech Street Commercial $106.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $105.73
Rate for Payer: Cash Price $76.30
Rate for Payer: ChoiceCare Network Commercial $105.73
Rate for Payer: Cigna of WY Commercial $106.82
Rate for Payer: Entrust Commercial $103.55
Rate for Payer: First Choice Health Commercial $103.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $103.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $62.13
Rate for Payer: HealthUtah PPO $109.00
Rate for Payer: Idaho Integrated Healthcare Commercial $105.73
Rate for Payer: Multiplan Medicare/VA $59.02
Rate for Payer: One Health Plan of WY PPO $106.82
Rate for Payer: PacificSource Commercial $98.10
Rate for Payer: PHCS PPO $106.82
Rate for Payer: Three Rivers PPO $81.75
Rate for Payer: TriWest Veterans Administration $62.13
Rate for Payer: United Healthcare Commercial $104.10
Rate for Payer: United Healthcare Medicare $62.13
Rate for Payer: WINHealth Partners Commercial $106.82
Rate for Payer: Wise Provider Network Commercial $103.55
Service Code HCPCS 12021
Hospital Charge Code 7611202101
Hospital Revenue Code 761
Min. Negotiated Rate $153.24
Max. Negotiated Rate $283.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $277.34
Rate for Payer: Aetna of WY Medicare $186.78
Rate for Payer: Altius Commercial $271.68
Rate for Payer: Beech Street Commercial $277.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $274.51
Rate for Payer: Cash Price $198.10
Rate for Payer: ChoiceCare Network Commercial $274.51
Rate for Payer: Cigna of WY Commercial $277.34
Rate for Payer: Entrust Commercial $268.85
Rate for Payer: First Choice Health Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $161.31
Rate for Payer: HealthUtah PPO $283.00
Rate for Payer: Idaho Integrated Healthcare Commercial $274.51
Rate for Payer: Multiplan Medicare/VA $153.24
Rate for Payer: One Health Plan of WY PPO $277.34
Rate for Payer: PacificSource Commercial $254.70
Rate for Payer: PHCS PPO $277.34
Rate for Payer: Three Rivers PPO $212.25
Rate for Payer: TriWest Veterans Administration $161.31
Rate for Payer: United Healthcare Commercial $270.26
Rate for Payer: United Healthcare Medicare $161.31
Rate for Payer: WINHealth Partners Commercial $277.34
Rate for Payer: Wise Provider Network Commercial $268.85
Service Code HCPCS 12021
Hospital Charge Code 7611202101
Hospital Revenue Code 761
Min. Negotiated Rate $164.00
Max. Negotiated Rate $283.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $277.34
Rate for Payer: Aetna of WY Medicare $181.12
Rate for Payer: Altius Commercial $271.68
Rate for Payer: Beech Street Commercial $277.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $274.51
Rate for Payer: Cash Price $198.10
Rate for Payer: ChoiceCare Network Commercial $274.51
Rate for Payer: Cigna of WY Commercial $277.34
Rate for Payer: Entrust Commercial $268.85
Rate for Payer: First Choice Health Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $268.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $172.63
Rate for Payer: HealthUtah PPO $283.00
Rate for Payer: Idaho Integrated Healthcare Commercial $274.51
Rate for Payer: Multiplan Medicare/VA $164.00
Rate for Payer: One Health Plan of WY PPO $277.34
Rate for Payer: PacificSource Commercial $254.70
Rate for Payer: PHCS PPO $277.34
Rate for Payer: Three Rivers PPO $212.25
Rate for Payer: TriWest Veterans Administration $172.63
Rate for Payer: United Healthcare Commercial $270.26
Rate for Payer: United Healthcare Medicare $172.63
Rate for Payer: WINHealth Partners Commercial $268.85
Rate for Payer: Wise Provider Network Commercial $268.85
Service Code HCPCS 85210
Hospital Charge Code 3058521001
Hospital Revenue Code 305
Min. Negotiated Rate $47.52
Max. Negotiated Rate $82.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $80.36
Rate for Payer: Aetna of WY Medicare $52.48
Rate for Payer: Altius Commercial $78.72
Rate for Payer: Beech Street Commercial $80.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $79.54
Rate for Payer: Cash Price $57.40
Rate for Payer: ChoiceCare Network Commercial $79.54
Rate for Payer: Cigna of WY Commercial $80.36
Rate for Payer: Entrust Commercial $77.90
Rate for Payer: First Choice Health Commercial $77.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $77.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $50.02
Rate for Payer: HealthUtah PPO $82.00
Rate for Payer: Idaho Integrated Healthcare Commercial $79.54
Rate for Payer: Multiplan Medicare/VA $47.52
Rate for Payer: One Health Plan of WY PPO $80.36
Rate for Payer: PacificSource Commercial $73.80
Rate for Payer: PHCS PPO $80.36
Rate for Payer: Three Rivers PPO $61.50
Rate for Payer: TriWest Veterans Administration $50.02
Rate for Payer: United Healthcare Commercial $78.31
Rate for Payer: United Healthcare Medicare $50.02
Rate for Payer: WINHealth Partners Commercial $77.90
Rate for Payer: Wise Provider Network Commercial $77.90
Service Code HCPCS 85210
Hospital Charge Code 3058521001
Hospital Revenue Code 305
Min. Negotiated Rate $44.40
Max. Negotiated Rate $82.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $80.36
Rate for Payer: Aetna of WY Medicare $54.12
Rate for Payer: Altius Commercial $78.72
Rate for Payer: Beech Street Commercial $80.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $79.54
Rate for Payer: Cash Price $57.40
Rate for Payer: ChoiceCare Network Commercial $79.54
Rate for Payer: Cigna of WY Commercial $80.36
Rate for Payer: Entrust Commercial $77.90
Rate for Payer: First Choice Health Commercial $77.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $77.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $46.74
Rate for Payer: HealthUtah PPO $82.00
Rate for Payer: Idaho Integrated Healthcare Commercial $79.54
Rate for Payer: Multiplan Medicare/VA $44.40
Rate for Payer: One Health Plan of WY PPO $80.36
Rate for Payer: PacificSource Commercial $73.80
Rate for Payer: PHCS PPO $80.36
Rate for Payer: Three Rivers PPO $61.50
Rate for Payer: TriWest Veterans Administration $46.74
Rate for Payer: United Healthcare Commercial $78.31
Rate for Payer: United Healthcare Medicare $46.74
Rate for Payer: WINHealth Partners Commercial $80.36
Rate for Payer: Wise Provider Network Commercial $77.90
Service Code HCPCS 85250
Hospital Charge Code 3058525001
Hospital Revenue Code 305
Min. Negotiated Rate $139.17
Max. Negotiated Rate $257.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $251.86
Rate for Payer: Aetna of WY Medicare $169.62
Rate for Payer: Altius Commercial $246.72
Rate for Payer: Beech Street Commercial $251.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $249.29
Rate for Payer: Cash Price $179.90
Rate for Payer: ChoiceCare Network Commercial $249.29
Rate for Payer: Cigna of WY Commercial $251.86
Rate for Payer: Entrust Commercial $244.15
Rate for Payer: First Choice Health Commercial $244.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $244.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $146.49
Rate for Payer: HealthUtah PPO $257.00
Rate for Payer: Idaho Integrated Healthcare Commercial $249.29
Rate for Payer: Multiplan Medicare/VA $139.17
Rate for Payer: One Health Plan of WY PPO $251.86
Rate for Payer: PacificSource Commercial $231.30
Rate for Payer: PHCS PPO $251.86
Rate for Payer: Three Rivers PPO $192.75
Rate for Payer: TriWest Veterans Administration $146.49
Rate for Payer: United Healthcare Commercial $245.44
Rate for Payer: United Healthcare Medicare $146.49
Rate for Payer: WINHealth Partners Commercial $251.86
Rate for Payer: Wise Provider Network Commercial $244.15
Service Code HCPCS 85250
Hospital Charge Code 3058525001
Hospital Revenue Code 305
Min. Negotiated Rate $148.93
Max. Negotiated Rate $257.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $251.86
Rate for Payer: Aetna of WY Medicare $164.48
Rate for Payer: Altius Commercial $246.72
Rate for Payer: Beech Street Commercial $251.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $249.29
Rate for Payer: Cash Price $179.90
Rate for Payer: ChoiceCare Network Commercial $249.29
Rate for Payer: Cigna of WY Commercial $251.86
Rate for Payer: Entrust Commercial $244.15
Rate for Payer: First Choice Health Commercial $244.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $244.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $156.77
Rate for Payer: HealthUtah PPO $257.00
Rate for Payer: Idaho Integrated Healthcare Commercial $249.29
Rate for Payer: Multiplan Medicare/VA $148.93
Rate for Payer: One Health Plan of WY PPO $251.86
Rate for Payer: PacificSource Commercial $231.30
Rate for Payer: PHCS PPO $251.86
Rate for Payer: Three Rivers PPO $192.75
Rate for Payer: TriWest Veterans Administration $156.77
Rate for Payer: United Healthcare Commercial $245.44
Rate for Payer: United Healthcare Medicare $156.77
Rate for Payer: WINHealth Partners Commercial $244.15
Rate for Payer: Wise Provider Network Commercial $244.15
Service Code HCPCS 85240
Hospital Charge Code 3058524001
Hospital Revenue Code 305
Min. Negotiated Rate $126.91
Max. Negotiated Rate $219.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $214.62
Rate for Payer: Aetna of WY Medicare $140.16
Rate for Payer: Altius Commercial $210.24
Rate for Payer: Beech Street Commercial $214.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $212.43
Rate for Payer: Cash Price $153.30
Rate for Payer: ChoiceCare Network Commercial $212.43
Rate for Payer: Cigna of WY Commercial $214.62
Rate for Payer: Entrust Commercial $208.05
Rate for Payer: First Choice Health Commercial $208.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $208.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $133.59
Rate for Payer: HealthUtah PPO $219.00
Rate for Payer: Idaho Integrated Healthcare Commercial $212.43
Rate for Payer: Multiplan Medicare/VA $126.91
Rate for Payer: One Health Plan of WY PPO $214.62
Rate for Payer: PacificSource Commercial $197.10
Rate for Payer: PHCS PPO $214.62
Rate for Payer: Three Rivers PPO $164.25
Rate for Payer: TriWest Veterans Administration $133.59
Rate for Payer: United Healthcare Commercial $209.14
Rate for Payer: United Healthcare Medicare $133.59
Rate for Payer: WINHealth Partners Commercial $208.05
Rate for Payer: Wise Provider Network Commercial $208.05
Service Code HCPCS 85240
Hospital Charge Code 3058524001
Hospital Revenue Code 305
Min. Negotiated Rate $118.59
Max. Negotiated Rate $219.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $214.62
Rate for Payer: Aetna of WY Medicare $144.54
Rate for Payer: Altius Commercial $210.24
Rate for Payer: Beech Street Commercial $214.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $212.43
Rate for Payer: Cash Price $153.30
Rate for Payer: ChoiceCare Network Commercial $212.43
Rate for Payer: Cigna of WY Commercial $214.62
Rate for Payer: Entrust Commercial $208.05
Rate for Payer: First Choice Health Commercial $208.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $208.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $124.83
Rate for Payer: HealthUtah PPO $219.00
Rate for Payer: Idaho Integrated Healthcare Commercial $212.43
Rate for Payer: Multiplan Medicare/VA $118.59
Rate for Payer: One Health Plan of WY PPO $214.62
Rate for Payer: PacificSource Commercial $197.10
Rate for Payer: PHCS PPO $214.62
Rate for Payer: Three Rivers PPO $164.25
Rate for Payer: TriWest Veterans Administration $124.83
Rate for Payer: United Healthcare Commercial $209.14
Rate for Payer: United Healthcare Medicare $124.83
Rate for Payer: WINHealth Partners Commercial $214.62
Rate for Payer: Wise Provider Network Commercial $208.05
Service Code HCPCS 85246
Hospital Charge Code 3058524603
Hospital Revenue Code 305
Min. Negotiated Rate $103.97
Max. Negotiated Rate $192.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $188.16
Rate for Payer: Aetna of WY Medicare $126.72
Rate for Payer: Altius Commercial $184.32
Rate for Payer: Beech Street Commercial $188.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $186.24
Rate for Payer: Cash Price $134.40
Rate for Payer: ChoiceCare Network Commercial $186.24
Rate for Payer: Cigna of WY Commercial $188.16
Rate for Payer: Entrust Commercial $182.40
Rate for Payer: First Choice Health Commercial $182.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $182.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $109.44
Rate for Payer: HealthUtah PPO $192.00
Rate for Payer: Idaho Integrated Healthcare Commercial $186.24
Rate for Payer: Multiplan Medicare/VA $103.97
Rate for Payer: One Health Plan of WY PPO $188.16
Rate for Payer: PacificSource Commercial $172.80
Rate for Payer: PHCS PPO $188.16
Rate for Payer: Three Rivers PPO $144.00
Rate for Payer: TriWest Veterans Administration $109.44
Rate for Payer: United Healthcare Commercial $183.36
Rate for Payer: United Healthcare Medicare $109.44
Rate for Payer: WINHealth Partners Commercial $188.16
Rate for Payer: Wise Provider Network Commercial $182.40
Service Code HCPCS 85246
Hospital Charge Code 3058524603
Hospital Revenue Code 305
Min. Negotiated Rate $111.26
Max. Negotiated Rate $192.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $188.16
Rate for Payer: Aetna of WY Medicare $122.88
Rate for Payer: Altius Commercial $184.32
Rate for Payer: Beech Street Commercial $188.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $186.24
Rate for Payer: Cash Price $134.40
Rate for Payer: ChoiceCare Network Commercial $186.24
Rate for Payer: Cigna of WY Commercial $188.16
Rate for Payer: Entrust Commercial $182.40
Rate for Payer: First Choice Health Commercial $182.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $182.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $117.12
Rate for Payer: HealthUtah PPO $192.00
Rate for Payer: Idaho Integrated Healthcare Commercial $186.24
Rate for Payer: Multiplan Medicare/VA $111.26
Rate for Payer: One Health Plan of WY PPO $188.16
Rate for Payer: PacificSource Commercial $172.80
Rate for Payer: PHCS PPO $188.16
Rate for Payer: Three Rivers PPO $144.00
Rate for Payer: TriWest Veterans Administration $117.12
Rate for Payer: United Healthcare Commercial $183.36
Rate for Payer: United Healthcare Medicare $117.12
Rate for Payer: WINHealth Partners Commercial $182.40
Rate for Payer: Wise Provider Network Commercial $182.40
Service Code HCPCS 85245
Hospital Charge Code 3058524501
Hospital Revenue Code 305
Min. Negotiated Rate $168.41
Max. Negotiated Rate $311.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $304.78
Rate for Payer: Aetna of WY Medicare $205.26
Rate for Payer: Altius Commercial $298.56
Rate for Payer: Beech Street Commercial $304.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $301.67
Rate for Payer: Cash Price $217.70
Rate for Payer: ChoiceCare Network Commercial $301.67
Rate for Payer: Cigna of WY Commercial $304.78
Rate for Payer: Entrust Commercial $295.45
Rate for Payer: First Choice Health Commercial $295.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $295.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $177.27
Rate for Payer: HealthUtah PPO $311.00
Rate for Payer: Idaho Integrated Healthcare Commercial $301.67
Rate for Payer: Multiplan Medicare/VA $168.41
Rate for Payer: One Health Plan of WY PPO $304.78
Rate for Payer: PacificSource Commercial $279.90
Rate for Payer: PHCS PPO $304.78
Rate for Payer: Three Rivers PPO $233.25
Rate for Payer: TriWest Veterans Administration $177.27
Rate for Payer: United Healthcare Commercial $297.00
Rate for Payer: United Healthcare Medicare $177.27
Rate for Payer: WINHealth Partners Commercial $304.78
Rate for Payer: Wise Provider Network Commercial $295.45
Service Code HCPCS 85245
Hospital Charge Code 3058524501
Hospital Revenue Code 305
Min. Negotiated Rate $180.22
Max. Negotiated Rate $311.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $304.78
Rate for Payer: Aetna of WY Medicare $199.04
Rate for Payer: Altius Commercial $298.56
Rate for Payer: Beech Street Commercial $304.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $301.67
Rate for Payer: Cash Price $217.70
Rate for Payer: ChoiceCare Network Commercial $301.67
Rate for Payer: Cigna of WY Commercial $304.78
Rate for Payer: Entrust Commercial $295.45
Rate for Payer: First Choice Health Commercial $295.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $295.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $189.71
Rate for Payer: HealthUtah PPO $311.00
Rate for Payer: Idaho Integrated Healthcare Commercial $301.67
Rate for Payer: Multiplan Medicare/VA $180.22
Rate for Payer: One Health Plan of WY PPO $304.78
Rate for Payer: PacificSource Commercial $279.90
Rate for Payer: PHCS PPO $304.78
Rate for Payer: Three Rivers PPO $233.25
Rate for Payer: TriWest Veterans Administration $189.71
Rate for Payer: United Healthcare Commercial $297.00
Rate for Payer: United Healthcare Medicare $189.71
Rate for Payer: WINHealth Partners Commercial $295.45
Rate for Payer: Wise Provider Network Commercial $295.45
Service Code HCPCS 85230
Hospital Charge Code 3058523001
Hospital Revenue Code 305
Min. Negotiated Rate $82.85
Max. Negotiated Rate $153.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $149.94
Rate for Payer: Aetna of WY Medicare $100.98
Rate for Payer: Altius Commercial $146.88
Rate for Payer: Beech Street Commercial $149.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $148.41
Rate for Payer: Cash Price $107.10
Rate for Payer: ChoiceCare Network Commercial $148.41
Rate for Payer: Cigna of WY Commercial $149.94
Rate for Payer: Entrust Commercial $145.35
Rate for Payer: First Choice Health Commercial $145.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $145.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.21
Rate for Payer: HealthUtah PPO $153.00
Rate for Payer: Idaho Integrated Healthcare Commercial $148.41
Rate for Payer: Multiplan Medicare/VA $82.85
Rate for Payer: One Health Plan of WY PPO $149.94
Rate for Payer: PacificSource Commercial $137.70
Rate for Payer: PHCS PPO $149.94
Rate for Payer: Three Rivers PPO $114.75
Rate for Payer: TriWest Veterans Administration $87.21
Rate for Payer: United Healthcare Commercial $146.12
Rate for Payer: United Healthcare Medicare $87.21
Rate for Payer: WINHealth Partners Commercial $149.94
Rate for Payer: Wise Provider Network Commercial $145.35
Service Code HCPCS 85230
Hospital Charge Code 3058523001
Hospital Revenue Code 305
Min. Negotiated Rate $88.66
Max. Negotiated Rate $153.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $149.94
Rate for Payer: Aetna of WY Medicare $97.92
Rate for Payer: Altius Commercial $146.88
Rate for Payer: Beech Street Commercial $149.94
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $148.41
Rate for Payer: Cash Price $107.10
Rate for Payer: ChoiceCare Network Commercial $148.41
Rate for Payer: Cigna of WY Commercial $149.94
Rate for Payer: Entrust Commercial $145.35
Rate for Payer: First Choice Health Commercial $145.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $145.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $93.33
Rate for Payer: HealthUtah PPO $153.00
Rate for Payer: Idaho Integrated Healthcare Commercial $148.41
Rate for Payer: Multiplan Medicare/VA $88.66
Rate for Payer: One Health Plan of WY PPO $149.94
Rate for Payer: PacificSource Commercial $137.70
Rate for Payer: PHCS PPO $149.94
Rate for Payer: Three Rivers PPO $114.75
Rate for Payer: TriWest Veterans Administration $93.33
Rate for Payer: United Healthcare Commercial $146.12
Rate for Payer: United Healthcare Medicare $93.33
Rate for Payer: WINHealth Partners Commercial $145.35
Rate for Payer: Wise Provider Network Commercial $145.35
Service Code HCPCS 85260
Hospital Charge Code 3058526001
Hospital Revenue Code 305
Min. Negotiated Rate $64.90
Max. Negotiated Rate $112.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $109.76
Rate for Payer: Aetna of WY Medicare $71.68
Rate for Payer: Altius Commercial $107.52
Rate for Payer: Beech Street Commercial $109.76
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $108.64
Rate for Payer: Cash Price $78.40
Rate for Payer: ChoiceCare Network Commercial $108.64
Rate for Payer: Cigna of WY Commercial $109.76
Rate for Payer: Entrust Commercial $106.40
Rate for Payer: First Choice Health Commercial $106.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $106.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $68.32
Rate for Payer: HealthUtah PPO $112.00
Rate for Payer: Idaho Integrated Healthcare Commercial $108.64
Rate for Payer: Multiplan Medicare/VA $64.90
Rate for Payer: One Health Plan of WY PPO $109.76
Rate for Payer: PacificSource Commercial $100.80
Rate for Payer: PHCS PPO $109.76
Rate for Payer: Three Rivers PPO $84.00
Rate for Payer: TriWest Veterans Administration $68.32
Rate for Payer: United Healthcare Commercial $106.96
Rate for Payer: United Healthcare Medicare $68.32
Rate for Payer: WINHealth Partners Commercial $106.40
Rate for Payer: Wise Provider Network Commercial $106.40
Service Code HCPCS 85260
Hospital Charge Code 3058526001
Hospital Revenue Code 305
Min. Negotiated Rate $60.65
Max. Negotiated Rate $112.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $109.76
Rate for Payer: Aetna of WY Medicare $73.92
Rate for Payer: Altius Commercial $107.52
Rate for Payer: Beech Street Commercial $109.76
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $108.64
Rate for Payer: Cash Price $78.40
Rate for Payer: ChoiceCare Network Commercial $108.64
Rate for Payer: Cigna of WY Commercial $109.76
Rate for Payer: Entrust Commercial $106.40
Rate for Payer: First Choice Health Commercial $106.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $106.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $63.84
Rate for Payer: HealthUtah PPO $112.00
Rate for Payer: Idaho Integrated Healthcare Commercial $108.64
Rate for Payer: Multiplan Medicare/VA $60.65
Rate for Payer: One Health Plan of WY PPO $109.76
Rate for Payer: PacificSource Commercial $100.80
Rate for Payer: PHCS PPO $109.76
Rate for Payer: Three Rivers PPO $84.00
Rate for Payer: TriWest Veterans Administration $63.84
Rate for Payer: United Healthcare Commercial $106.96
Rate for Payer: United Healthcare Medicare $63.84
Rate for Payer: WINHealth Partners Commercial $109.76
Rate for Payer: Wise Provider Network Commercial $106.40
Service Code HCPCS 85303
Hospital Charge Code 3058530301
Hospital Revenue Code 305
Min. Negotiated Rate $147.83
Max. Negotiated Rate $273.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $267.54
Rate for Payer: Aetna of WY Medicare $180.18
Rate for Payer: Altius Commercial $262.08
Rate for Payer: Beech Street Commercial $267.54
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $264.81
Rate for Payer: Cash Price $191.10
Rate for Payer: ChoiceCare Network Commercial $264.81
Rate for Payer: Cigna of WY Commercial $267.54
Rate for Payer: Entrust Commercial $259.35
Rate for Payer: First Choice Health Commercial $259.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $259.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $155.61
Rate for Payer: HealthUtah PPO $273.00
Rate for Payer: Idaho Integrated Healthcare Commercial $264.81
Rate for Payer: Multiplan Medicare/VA $147.83
Rate for Payer: One Health Plan of WY PPO $267.54
Rate for Payer: PacificSource Commercial $245.70
Rate for Payer: PHCS PPO $267.54
Rate for Payer: Three Rivers PPO $204.75
Rate for Payer: TriWest Veterans Administration $155.61
Rate for Payer: United Healthcare Commercial $260.72
Rate for Payer: United Healthcare Medicare $155.61
Rate for Payer: WINHealth Partners Commercial $267.54
Rate for Payer: Wise Provider Network Commercial $259.35
Service Code HCPCS 85303
Hospital Charge Code 3058530301
Hospital Revenue Code 305
Min. Negotiated Rate $158.20
Max. Negotiated Rate $273.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $267.54
Rate for Payer: Aetna of WY Medicare $174.72
Rate for Payer: Altius Commercial $262.08
Rate for Payer: Beech Street Commercial $267.54
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $264.81
Rate for Payer: Cash Price $191.10
Rate for Payer: ChoiceCare Network Commercial $264.81
Rate for Payer: Cigna of WY Commercial $267.54
Rate for Payer: Entrust Commercial $259.35
Rate for Payer: First Choice Health Commercial $259.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $259.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $166.53
Rate for Payer: HealthUtah PPO $273.00
Rate for Payer: Idaho Integrated Healthcare Commercial $264.81
Rate for Payer: Multiplan Medicare/VA $158.20
Rate for Payer: One Health Plan of WY PPO $267.54
Rate for Payer: PacificSource Commercial $245.70
Rate for Payer: PHCS PPO $267.54
Rate for Payer: Three Rivers PPO $204.75
Rate for Payer: TriWest Veterans Administration $166.53
Rate for Payer: United Healthcare Commercial $260.72
Rate for Payer: United Healthcare Medicare $166.53
Rate for Payer: WINHealth Partners Commercial $259.35
Rate for Payer: Wise Provider Network Commercial $259.35