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Service Code HCPCS 85306
Hospital Charge Code 3058530601
Hospital Revenue Code 305
Min. Negotiated Rate $150.67
Max. Negotiated Rate $260.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $254.80
Rate for Payer: Aetna of WY Medicare $166.40
Rate for Payer: Altius Commercial $249.60
Rate for Payer: Beech Street Commercial $254.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $252.20
Rate for Payer: Cash Price $182.00
Rate for Payer: ChoiceCare Network Commercial $252.20
Rate for Payer: Cigna of WY Commercial $254.80
Rate for Payer: Entrust Commercial $247.00
Rate for Payer: First Choice Health Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $158.60
Rate for Payer: HealthUtah PPO $260.00
Rate for Payer: Idaho Integrated Healthcare Commercial $252.20
Rate for Payer: Multiplan Medicare/VA $150.67
Rate for Payer: One Health Plan of WY PPO $254.80
Rate for Payer: PacificSource Commercial $234.00
Rate for Payer: PHCS PPO $254.80
Rate for Payer: Three Rivers PPO $195.00
Rate for Payer: TriWest Veterans Administration $158.60
Rate for Payer: United Healthcare Commercial $248.30
Rate for Payer: United Healthcare Medicare $158.60
Rate for Payer: WINHealth Partners Commercial $247.00
Rate for Payer: Wise Provider Network Commercial $247.00
Service Code HCPCS 85306
Hospital Charge Code 3058530601
Hospital Revenue Code 305
Min. Negotiated Rate $140.79
Max. Negotiated Rate $260.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $254.80
Rate for Payer: Aetna of WY Medicare $171.60
Rate for Payer: Altius Commercial $249.60
Rate for Payer: Beech Street Commercial $254.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $252.20
Rate for Payer: Cash Price $182.00
Rate for Payer: ChoiceCare Network Commercial $252.20
Rate for Payer: Cigna of WY Commercial $254.80
Rate for Payer: Entrust Commercial $247.00
Rate for Payer: First Choice Health Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $148.20
Rate for Payer: HealthUtah PPO $260.00
Rate for Payer: Idaho Integrated Healthcare Commercial $252.20
Rate for Payer: Multiplan Medicare/VA $140.79
Rate for Payer: One Health Plan of WY PPO $254.80
Rate for Payer: PacificSource Commercial $234.00
Rate for Payer: PHCS PPO $254.80
Rate for Payer: Three Rivers PPO $195.00
Rate for Payer: TriWest Veterans Administration $148.20
Rate for Payer: United Healthcare Commercial $248.30
Rate for Payer: United Healthcare Medicare $148.20
Rate for Payer: WINHealth Partners Commercial $254.80
Rate for Payer: Wise Provider Network Commercial $247.00
Service Code HCPCS 85306
Hospital Charge Code 3058530602
Hospital Revenue Code 305
Min. Negotiated Rate $140.79
Max. Negotiated Rate $260.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $254.80
Rate for Payer: Aetna of WY Medicare $171.60
Rate for Payer: Altius Commercial $249.60
Rate for Payer: Beech Street Commercial $254.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $252.20
Rate for Payer: Cash Price $182.00
Rate for Payer: ChoiceCare Network Commercial $252.20
Rate for Payer: Cigna of WY Commercial $254.80
Rate for Payer: Entrust Commercial $247.00
Rate for Payer: First Choice Health Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $148.20
Rate for Payer: HealthUtah PPO $260.00
Rate for Payer: Idaho Integrated Healthcare Commercial $252.20
Rate for Payer: Multiplan Medicare/VA $140.79
Rate for Payer: One Health Plan of WY PPO $254.80
Rate for Payer: PacificSource Commercial $234.00
Rate for Payer: PHCS PPO $254.80
Rate for Payer: Three Rivers PPO $195.00
Rate for Payer: TriWest Veterans Administration $148.20
Rate for Payer: United Healthcare Commercial $248.30
Rate for Payer: United Healthcare Medicare $148.20
Rate for Payer: WINHealth Partners Commercial $254.80
Rate for Payer: Wise Provider Network Commercial $247.00
Service Code HCPCS 85306
Hospital Charge Code 3058530602
Hospital Revenue Code 305
Min. Negotiated Rate $150.67
Max. Negotiated Rate $260.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $254.80
Rate for Payer: Aetna of WY Medicare $166.40
Rate for Payer: Altius Commercial $249.60
Rate for Payer: Beech Street Commercial $254.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $252.20
Rate for Payer: Cash Price $182.00
Rate for Payer: ChoiceCare Network Commercial $252.20
Rate for Payer: Cigna of WY Commercial $254.80
Rate for Payer: Entrust Commercial $247.00
Rate for Payer: First Choice Health Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $247.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $158.60
Rate for Payer: HealthUtah PPO $260.00
Rate for Payer: Idaho Integrated Healthcare Commercial $252.20
Rate for Payer: Multiplan Medicare/VA $150.67
Rate for Payer: One Health Plan of WY PPO $254.80
Rate for Payer: PacificSource Commercial $234.00
Rate for Payer: PHCS PPO $254.80
Rate for Payer: Three Rivers PPO $195.00
Rate for Payer: TriWest Veterans Administration $158.60
Rate for Payer: United Healthcare Commercial $248.30
Rate for Payer: United Healthcare Medicare $158.60
Rate for Payer: WINHealth Partners Commercial $247.00
Rate for Payer: Wise Provider Network Commercial $247.00
Service Code HCPCS 86644
Hospital Charge Code 3028664401
Hospital Revenue Code 302
Min. Negotiated Rate $84.47
Max. Negotiated Rate $156.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $152.88
Rate for Payer: Aetna of WY Medicare $102.96
Rate for Payer: Altius Commercial $149.76
Rate for Payer: Beech Street Commercial $152.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $151.32
Rate for Payer: Cash Price $109.20
Rate for Payer: ChoiceCare Network Commercial $151.32
Rate for Payer: Cigna of WY Commercial $152.88
Rate for Payer: Entrust Commercial $148.20
Rate for Payer: First Choice Health Commercial $148.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $148.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $88.92
Rate for Payer: HealthUtah PPO $156.00
Rate for Payer: Idaho Integrated Healthcare Commercial $151.32
Rate for Payer: Multiplan Medicare/VA $84.47
Rate for Payer: One Health Plan of WY PPO $152.88
Rate for Payer: PacificSource Commercial $140.40
Rate for Payer: PHCS PPO $152.88
Rate for Payer: Three Rivers PPO $117.00
Rate for Payer: TriWest Veterans Administration $88.92
Rate for Payer: United Healthcare Commercial $148.98
Rate for Payer: United Healthcare Medicare $88.92
Rate for Payer: WINHealth Partners Commercial $152.88
Rate for Payer: Wise Provider Network Commercial $148.20
Service Code HCPCS 86644
Hospital Charge Code 3028664401
Hospital Revenue Code 302
Min. Negotiated Rate $90.40
Max. Negotiated Rate $156.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $152.88
Rate for Payer: Aetna of WY Medicare $99.84
Rate for Payer: Altius Commercial $149.76
Rate for Payer: Beech Street Commercial $152.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $151.32
Rate for Payer: Cash Price $109.20
Rate for Payer: ChoiceCare Network Commercial $151.32
Rate for Payer: Cigna of WY Commercial $152.88
Rate for Payer: Entrust Commercial $148.20
Rate for Payer: First Choice Health Commercial $148.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $148.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $95.16
Rate for Payer: HealthUtah PPO $156.00
Rate for Payer: Idaho Integrated Healthcare Commercial $151.32
Rate for Payer: Multiplan Medicare/VA $90.40
Rate for Payer: One Health Plan of WY PPO $152.88
Rate for Payer: PacificSource Commercial $140.40
Rate for Payer: PHCS PPO $152.88
Rate for Payer: Three Rivers PPO $117.00
Rate for Payer: TriWest Veterans Administration $95.16
Rate for Payer: United Healthcare Commercial $148.98
Rate for Payer: United Healthcare Medicare $95.16
Rate for Payer: WINHealth Partners Commercial $148.20
Rate for Payer: Wise Provider Network Commercial $148.20
Service Code HCPCS 86645
Hospital Charge Code 3028664501
Hospital Revenue Code 302
Min. Negotiated Rate $155.89
Max. Negotiated Rate $269.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $263.62
Rate for Payer: Aetna of WY Medicare $172.16
Rate for Payer: Altius Commercial $258.24
Rate for Payer: Beech Street Commercial $263.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $260.93
Rate for Payer: Cash Price $188.30
Rate for Payer: ChoiceCare Network Commercial $260.93
Rate for Payer: Cigna of WY Commercial $263.62
Rate for Payer: Entrust Commercial $255.55
Rate for Payer: First Choice Health Commercial $255.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $255.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $164.09
Rate for Payer: HealthUtah PPO $269.00
Rate for Payer: Idaho Integrated Healthcare Commercial $260.93
Rate for Payer: Multiplan Medicare/VA $155.89
Rate for Payer: One Health Plan of WY PPO $263.62
Rate for Payer: PacificSource Commercial $242.10
Rate for Payer: PHCS PPO $263.62
Rate for Payer: Three Rivers PPO $201.75
Rate for Payer: TriWest Veterans Administration $164.09
Rate for Payer: United Healthcare Commercial $256.90
Rate for Payer: United Healthcare Medicare $164.09
Rate for Payer: WINHealth Partners Commercial $255.55
Rate for Payer: Wise Provider Network Commercial $255.55
Service Code HCPCS 86645 90
Hospital Charge Code 3028664501
Hospital Revenue Code 302
Min. Negotiated Rate $111.84
Max. Negotiated Rate $193.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $189.14
Rate for Payer: Aetna of WY Medicare $123.52
Rate for Payer: Altius Commercial $185.28
Rate for Payer: Beech Street Commercial $189.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $187.21
Rate for Payer: Cash Price $135.10
Rate for Payer: ChoiceCare Network Commercial $187.21
Rate for Payer: Cigna of WY Commercial $189.14
Rate for Payer: Entrust Commercial $183.35
Rate for Payer: First Choice Health Commercial $183.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $183.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $117.73
Rate for Payer: HealthUtah PPO $193.00
Rate for Payer: Idaho Integrated Healthcare Commercial $187.21
Rate for Payer: Multiplan Medicare/VA $111.84
Rate for Payer: One Health Plan of WY PPO $189.14
Rate for Payer: PacificSource Commercial $173.70
Rate for Payer: PHCS PPO $189.14
Rate for Payer: Three Rivers PPO $144.75
Rate for Payer: TriWest Veterans Administration $117.73
Rate for Payer: United Healthcare Commercial $184.32
Rate for Payer: United Healthcare Medicare $117.73
Rate for Payer: WINHealth Partners Commercial $183.35
Rate for Payer: Wise Provider Network Commercial $183.35
Service Code HCPCS 86645 90
Hospital Charge Code 3028664501
Hospital Revenue Code 302
Min. Negotiated Rate $104.51
Max. Negotiated Rate $193.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $189.14
Rate for Payer: Aetna of WY Medicare $127.38
Rate for Payer: Altius Commercial $185.28
Rate for Payer: Beech Street Commercial $189.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $187.21
Rate for Payer: Cash Price $135.10
Rate for Payer: ChoiceCare Network Commercial $187.21
Rate for Payer: Cigna of WY Commercial $189.14
Rate for Payer: Entrust Commercial $183.35
Rate for Payer: First Choice Health Commercial $183.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $183.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $110.01
Rate for Payer: HealthUtah PPO $193.00
Rate for Payer: Idaho Integrated Healthcare Commercial $187.21
Rate for Payer: Multiplan Medicare/VA $104.51
Rate for Payer: One Health Plan of WY PPO $189.14
Rate for Payer: PacificSource Commercial $173.70
Rate for Payer: PHCS PPO $189.14
Rate for Payer: Three Rivers PPO $144.75
Rate for Payer: TriWest Veterans Administration $110.01
Rate for Payer: United Healthcare Commercial $184.32
Rate for Payer: United Healthcare Medicare $110.01
Rate for Payer: WINHealth Partners Commercial $189.14
Rate for Payer: Wise Provider Network Commercial $183.35
Service Code HCPCS 86645
Hospital Charge Code 3028664501
Hospital Revenue Code 302
Min. Negotiated Rate $145.66
Max. Negotiated Rate $269.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $263.62
Rate for Payer: Aetna of WY Medicare $177.54
Rate for Payer: Altius Commercial $258.24
Rate for Payer: Beech Street Commercial $263.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $260.93
Rate for Payer: Cash Price $188.30
Rate for Payer: ChoiceCare Network Commercial $260.93
Rate for Payer: Cigna of WY Commercial $263.62
Rate for Payer: Entrust Commercial $255.55
Rate for Payer: First Choice Health Commercial $255.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $255.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $153.33
Rate for Payer: HealthUtah PPO $269.00
Rate for Payer: Idaho Integrated Healthcare Commercial $260.93
Rate for Payer: Multiplan Medicare/VA $145.66
Rate for Payer: One Health Plan of WY PPO $263.62
Rate for Payer: PacificSource Commercial $242.10
Rate for Payer: PHCS PPO $263.62
Rate for Payer: Three Rivers PPO $201.75
Rate for Payer: TriWest Veterans Administration $153.33
Rate for Payer: United Healthcare Commercial $256.90
Rate for Payer: United Healthcare Medicare $153.33
Rate for Payer: WINHealth Partners Commercial $263.62
Rate for Payer: Wise Provider Network Commercial $255.55
Service Code HCPCS 86645
Hospital Charge Code 3028664502
Hospital Revenue Code 302
Min. Negotiated Rate $111.84
Max. Negotiated Rate $193.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $189.14
Rate for Payer: Aetna of WY Medicare $123.52
Rate for Payer: Altius Commercial $185.28
Rate for Payer: Beech Street Commercial $189.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $187.21
Rate for Payer: Cash Price $135.10
Rate for Payer: ChoiceCare Network Commercial $187.21
Rate for Payer: Cigna of WY Commercial $189.14
Rate for Payer: Entrust Commercial $183.35
Rate for Payer: First Choice Health Commercial $183.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $183.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $117.73
Rate for Payer: HealthUtah PPO $193.00
Rate for Payer: Idaho Integrated Healthcare Commercial $187.21
Rate for Payer: Multiplan Medicare/VA $111.84
Rate for Payer: One Health Plan of WY PPO $189.14
Rate for Payer: PacificSource Commercial $173.70
Rate for Payer: PHCS PPO $189.14
Rate for Payer: Three Rivers PPO $144.75
Rate for Payer: TriWest Veterans Administration $117.73
Rate for Payer: United Healthcare Commercial $184.32
Rate for Payer: United Healthcare Medicare $117.73
Rate for Payer: WINHealth Partners Commercial $183.35
Rate for Payer: Wise Provider Network Commercial $183.35
Service Code HCPCS 86645
Hospital Charge Code 3028664502
Hospital Revenue Code 302
Min. Negotiated Rate $104.51
Max. Negotiated Rate $193.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $189.14
Rate for Payer: Aetna of WY Medicare $127.38
Rate for Payer: Altius Commercial $185.28
Rate for Payer: Beech Street Commercial $189.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $187.21
Rate for Payer: Cash Price $135.10
Rate for Payer: ChoiceCare Network Commercial $187.21
Rate for Payer: Cigna of WY Commercial $189.14
Rate for Payer: Entrust Commercial $183.35
Rate for Payer: First Choice Health Commercial $183.35
Rate for Payer: Government Employees Health Association (GEHA) Commercial $183.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $110.01
Rate for Payer: HealthUtah PPO $193.00
Rate for Payer: Idaho Integrated Healthcare Commercial $187.21
Rate for Payer: Multiplan Medicare/VA $104.51
Rate for Payer: One Health Plan of WY PPO $189.14
Rate for Payer: PacificSource Commercial $173.70
Rate for Payer: PHCS PPO $189.14
Rate for Payer: Three Rivers PPO $144.75
Rate for Payer: TriWest Veterans Administration $110.01
Rate for Payer: United Healthcare Commercial $184.32
Rate for Payer: United Healthcare Medicare $110.01
Rate for Payer: WINHealth Partners Commercial $189.14
Rate for Payer: Wise Provider Network Commercial $183.35
Service Code HCPCS 30906
Hospital Charge Code 7613090601
Hospital Revenue Code 761
Min. Negotiated Rate $246.92
Max. Negotiated Rate $456.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $446.88
Rate for Payer: Aetna of WY Medicare $300.96
Rate for Payer: Altius Commercial $437.76
Rate for Payer: Beech Street Commercial $446.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $442.32
Rate for Payer: Cash Price $319.20
Rate for Payer: ChoiceCare Network Commercial $442.32
Rate for Payer: Cigna of WY Commercial $446.88
Rate for Payer: Entrust Commercial $433.20
Rate for Payer: First Choice Health Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $259.92
Rate for Payer: HealthUtah PPO $456.00
Rate for Payer: Idaho Integrated Healthcare Commercial $442.32
Rate for Payer: Multiplan Medicare/VA $246.92
Rate for Payer: One Health Plan of WY PPO $446.88
Rate for Payer: PacificSource Commercial $410.40
Rate for Payer: PHCS PPO $446.88
Rate for Payer: Three Rivers PPO $342.00
Rate for Payer: TriWest Veterans Administration $259.92
Rate for Payer: United Healthcare Commercial $435.48
Rate for Payer: United Healthcare Medicare $259.92
Rate for Payer: WINHealth Partners Commercial $446.88
Rate for Payer: Wise Provider Network Commercial $433.20
Service Code HCPCS 30906
Hospital Charge Code 7613090601
Hospital Revenue Code 761
Min. Negotiated Rate $264.25
Max. Negotiated Rate $456.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $446.88
Rate for Payer: Aetna of WY Medicare $291.84
Rate for Payer: Altius Commercial $437.76
Rate for Payer: Beech Street Commercial $446.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $442.32
Rate for Payer: Cash Price $319.20
Rate for Payer: ChoiceCare Network Commercial $442.32
Rate for Payer: Cigna of WY Commercial $446.88
Rate for Payer: Entrust Commercial $433.20
Rate for Payer: First Choice Health Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $278.16
Rate for Payer: HealthUtah PPO $456.00
Rate for Payer: Idaho Integrated Healthcare Commercial $442.32
Rate for Payer: Multiplan Medicare/VA $264.25
Rate for Payer: One Health Plan of WY PPO $446.88
Rate for Payer: PacificSource Commercial $410.40
Rate for Payer: PHCS PPO $446.88
Rate for Payer: Three Rivers PPO $342.00
Rate for Payer: TriWest Veterans Administration $278.16
Rate for Payer: United Healthcare Commercial $435.48
Rate for Payer: United Healthcare Medicare $278.16
Rate for Payer: WINHealth Partners Commercial $433.20
Rate for Payer: Wise Provider Network Commercial $433.20
Service Code HCPCS 42962
Hospital Charge Code 7614296201
Hospital Revenue Code 761
Min. Negotiated Rate $246.92
Max. Negotiated Rate $456.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $446.88
Rate for Payer: Aetna of WY Medicare $300.96
Rate for Payer: Altius Commercial $437.76
Rate for Payer: Beech Street Commercial $446.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $442.32
Rate for Payer: Cash Price $319.20
Rate for Payer: ChoiceCare Network Commercial $442.32
Rate for Payer: Cigna of WY Commercial $446.88
Rate for Payer: Entrust Commercial $433.20
Rate for Payer: First Choice Health Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $259.92
Rate for Payer: HealthUtah PPO $456.00
Rate for Payer: Idaho Integrated Healthcare Commercial $442.32
Rate for Payer: Multiplan Medicare/VA $246.92
Rate for Payer: One Health Plan of WY PPO $446.88
Rate for Payer: PacificSource Commercial $410.40
Rate for Payer: PHCS PPO $446.88
Rate for Payer: Three Rivers PPO $342.00
Rate for Payer: TriWest Veterans Administration $259.92
Rate for Payer: United Healthcare Commercial $435.48
Rate for Payer: United Healthcare Medicare $259.92
Rate for Payer: WINHealth Partners Commercial $446.88
Rate for Payer: Wise Provider Network Commercial $433.20
Service Code HCPCS 42962
Hospital Charge Code 7614296201
Hospital Revenue Code 761
Min. Negotiated Rate $264.25
Max. Negotiated Rate $456.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $446.88
Rate for Payer: Aetna of WY Medicare $291.84
Rate for Payer: Altius Commercial $437.76
Rate for Payer: Beech Street Commercial $446.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $442.32
Rate for Payer: Cash Price $319.20
Rate for Payer: ChoiceCare Network Commercial $442.32
Rate for Payer: Cigna of WY Commercial $446.88
Rate for Payer: Entrust Commercial $433.20
Rate for Payer: First Choice Health Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $433.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $278.16
Rate for Payer: HealthUtah PPO $456.00
Rate for Payer: Idaho Integrated Healthcare Commercial $442.32
Rate for Payer: Multiplan Medicare/VA $264.25
Rate for Payer: One Health Plan of WY PPO $446.88
Rate for Payer: PacificSource Commercial $410.40
Rate for Payer: PHCS PPO $446.88
Rate for Payer: Three Rivers PPO $342.00
Rate for Payer: TriWest Veterans Administration $278.16
Rate for Payer: United Healthcare Commercial $435.48
Rate for Payer: United Healthcare Medicare $278.16
Rate for Payer: WINHealth Partners Commercial $433.20
Rate for Payer: Wise Provider Network Commercial $433.20
Service Code HCPCS 86635
Hospital Charge Code 3028663503
Hospital Revenue Code 302
Min. Negotiated Rate $135.92
Max. Negotiated Rate $251.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $245.98
Rate for Payer: Aetna of WY Medicare $165.66
Rate for Payer: Altius Commercial $240.96
Rate for Payer: Beech Street Commercial $245.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $243.47
Rate for Payer: Cash Price $175.70
Rate for Payer: ChoiceCare Network Commercial $243.47
Rate for Payer: Cigna of WY Commercial $245.98
Rate for Payer: Entrust Commercial $238.45
Rate for Payer: First Choice Health Commercial $238.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $238.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $143.07
Rate for Payer: HealthUtah PPO $251.00
Rate for Payer: Idaho Integrated Healthcare Commercial $243.47
Rate for Payer: Multiplan Medicare/VA $135.92
Rate for Payer: One Health Plan of WY PPO $245.98
Rate for Payer: PacificSource Commercial $225.90
Rate for Payer: PHCS PPO $245.98
Rate for Payer: Three Rivers PPO $188.25
Rate for Payer: TriWest Veterans Administration $143.07
Rate for Payer: United Healthcare Commercial $239.70
Rate for Payer: United Healthcare Medicare $143.07
Rate for Payer: WINHealth Partners Commercial $245.98
Rate for Payer: Wise Provider Network Commercial $238.45
Service Code HCPCS 86635
Hospital Charge Code 3028663503
Hospital Revenue Code 302
Min. Negotiated Rate $145.45
Max. Negotiated Rate $251.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $245.98
Rate for Payer: Aetna of WY Medicare $160.64
Rate for Payer: Altius Commercial $240.96
Rate for Payer: Beech Street Commercial $245.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $243.47
Rate for Payer: Cash Price $175.70
Rate for Payer: ChoiceCare Network Commercial $243.47
Rate for Payer: Cigna of WY Commercial $245.98
Rate for Payer: Entrust Commercial $238.45
Rate for Payer: First Choice Health Commercial $238.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $238.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $153.11
Rate for Payer: HealthUtah PPO $251.00
Rate for Payer: Idaho Integrated Healthcare Commercial $243.47
Rate for Payer: Multiplan Medicare/VA $145.45
Rate for Payer: One Health Plan of WY PPO $245.98
Rate for Payer: PacificSource Commercial $225.90
Rate for Payer: PHCS PPO $245.98
Rate for Payer: Three Rivers PPO $188.25
Rate for Payer: TriWest Veterans Administration $153.11
Rate for Payer: United Healthcare Commercial $239.70
Rate for Payer: United Healthcare Medicare $153.11
Rate for Payer: WINHealth Partners Commercial $238.45
Rate for Payer: Wise Provider Network Commercial $238.45
Service Code HCPCS 86635
Hospital Charge Code 3028663504
Hospital Revenue Code 302
Min. Negotiated Rate $132.13
Max. Negotiated Rate $228.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $223.44
Rate for Payer: Aetna of WY Medicare $145.92
Rate for Payer: Altius Commercial $218.88
Rate for Payer: Beech Street Commercial $223.44
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $221.16
Rate for Payer: Cash Price $159.60
Rate for Payer: ChoiceCare Network Commercial $221.16
Rate for Payer: Cigna of WY Commercial $223.44
Rate for Payer: Entrust Commercial $216.60
Rate for Payer: First Choice Health Commercial $216.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $216.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $139.08
Rate for Payer: HealthUtah PPO $228.00
Rate for Payer: Idaho Integrated Healthcare Commercial $221.16
Rate for Payer: Multiplan Medicare/VA $132.13
Rate for Payer: One Health Plan of WY PPO $223.44
Rate for Payer: PacificSource Commercial $205.20
Rate for Payer: PHCS PPO $223.44
Rate for Payer: Three Rivers PPO $171.00
Rate for Payer: TriWest Veterans Administration $139.08
Rate for Payer: United Healthcare Commercial $217.74
Rate for Payer: United Healthcare Medicare $139.08
Rate for Payer: WINHealth Partners Commercial $216.60
Rate for Payer: Wise Provider Network Commercial $216.60
Service Code HCPCS 86635
Hospital Charge Code 3028663504
Hospital Revenue Code 302
Min. Negotiated Rate $123.46
Max. Negotiated Rate $228.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $223.44
Rate for Payer: Aetna of WY Medicare $150.48
Rate for Payer: Altius Commercial $218.88
Rate for Payer: Beech Street Commercial $223.44
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $221.16
Rate for Payer: Cash Price $159.60
Rate for Payer: ChoiceCare Network Commercial $221.16
Rate for Payer: Cigna of WY Commercial $223.44
Rate for Payer: Entrust Commercial $216.60
Rate for Payer: First Choice Health Commercial $216.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $216.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $129.96
Rate for Payer: HealthUtah PPO $228.00
Rate for Payer: Idaho Integrated Healthcare Commercial $221.16
Rate for Payer: Multiplan Medicare/VA $123.46
Rate for Payer: One Health Plan of WY PPO $223.44
Rate for Payer: PacificSource Commercial $205.20
Rate for Payer: PHCS PPO $223.44
Rate for Payer: Three Rivers PPO $171.00
Rate for Payer: TriWest Veterans Administration $129.96
Rate for Payer: United Healthcare Commercial $217.74
Rate for Payer: United Healthcare Medicare $129.96
Rate for Payer: WINHealth Partners Commercial $223.44
Rate for Payer: Wise Provider Network Commercial $216.60
Service Code HCPCS 86635
Hospital Charge Code 3028663505
Hospital Revenue Code 302
Min. Negotiated Rate $132.13
Max. Negotiated Rate $228.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $223.44
Rate for Payer: Aetna of WY Medicare $145.92
Rate for Payer: Altius Commercial $218.88
Rate for Payer: Beech Street Commercial $223.44
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $221.16
Rate for Payer: Cash Price $159.60
Rate for Payer: ChoiceCare Network Commercial $221.16
Rate for Payer: Cigna of WY Commercial $223.44
Rate for Payer: Entrust Commercial $216.60
Rate for Payer: First Choice Health Commercial $216.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $216.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $139.08
Rate for Payer: HealthUtah PPO $228.00
Rate for Payer: Idaho Integrated Healthcare Commercial $221.16
Rate for Payer: Multiplan Medicare/VA $132.13
Rate for Payer: One Health Plan of WY PPO $223.44
Rate for Payer: PacificSource Commercial $205.20
Rate for Payer: PHCS PPO $223.44
Rate for Payer: Three Rivers PPO $171.00
Rate for Payer: TriWest Veterans Administration $139.08
Rate for Payer: United Healthcare Commercial $217.74
Rate for Payer: United Healthcare Medicare $139.08
Rate for Payer: WINHealth Partners Commercial $216.60
Rate for Payer: Wise Provider Network Commercial $216.60
Service Code HCPCS 86635
Hospital Charge Code 3028663505
Hospital Revenue Code 302
Min. Negotiated Rate $123.46
Max. Negotiated Rate $228.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $223.44
Rate for Payer: Aetna of WY Medicare $150.48
Rate for Payer: Altius Commercial $218.88
Rate for Payer: Beech Street Commercial $223.44
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $221.16
Rate for Payer: Cash Price $159.60
Rate for Payer: ChoiceCare Network Commercial $221.16
Rate for Payer: Cigna of WY Commercial $223.44
Rate for Payer: Entrust Commercial $216.60
Rate for Payer: First Choice Health Commercial $216.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $216.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $129.96
Rate for Payer: HealthUtah PPO $228.00
Rate for Payer: Idaho Integrated Healthcare Commercial $221.16
Rate for Payer: Multiplan Medicare/VA $123.46
Rate for Payer: One Health Plan of WY PPO $223.44
Rate for Payer: PacificSource Commercial $205.20
Rate for Payer: PHCS PPO $223.44
Rate for Payer: Three Rivers PPO $171.00
Rate for Payer: TriWest Veterans Administration $129.96
Rate for Payer: United Healthcare Commercial $217.74
Rate for Payer: United Healthcare Medicare $129.96
Rate for Payer: WINHealth Partners Commercial $223.44
Rate for Payer: Wise Provider Network Commercial $216.60
Service Code HCPCS 86635
Hospital Charge Code 3028663502
Hospital Revenue Code 302
Min. Negotiated Rate $135.92
Max. Negotiated Rate $251.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $245.98
Rate for Payer: Aetna of WY Medicare $165.66
Rate for Payer: Altius Commercial $240.96
Rate for Payer: Beech Street Commercial $245.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $243.47
Rate for Payer: Cash Price $175.70
Rate for Payer: ChoiceCare Network Commercial $243.47
Rate for Payer: Cigna of WY Commercial $245.98
Rate for Payer: Entrust Commercial $238.45
Rate for Payer: First Choice Health Commercial $238.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $238.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $143.07
Rate for Payer: HealthUtah PPO $251.00
Rate for Payer: Idaho Integrated Healthcare Commercial $243.47
Rate for Payer: Multiplan Medicare/VA $135.92
Rate for Payer: One Health Plan of WY PPO $245.98
Rate for Payer: PacificSource Commercial $225.90
Rate for Payer: PHCS PPO $245.98
Rate for Payer: Three Rivers PPO $188.25
Rate for Payer: TriWest Veterans Administration $143.07
Rate for Payer: United Healthcare Commercial $239.70
Rate for Payer: United Healthcare Medicare $143.07
Rate for Payer: WINHealth Partners Commercial $245.98
Rate for Payer: Wise Provider Network Commercial $238.45
Service Code HCPCS 86635
Hospital Charge Code 3028663502
Hospital Revenue Code 302
Min. Negotiated Rate $145.45
Max. Negotiated Rate $251.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $245.98
Rate for Payer: Aetna of WY Medicare $160.64
Rate for Payer: Altius Commercial $240.96
Rate for Payer: Beech Street Commercial $245.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $243.47
Rate for Payer: Cash Price $175.70
Rate for Payer: ChoiceCare Network Commercial $243.47
Rate for Payer: Cigna of WY Commercial $245.98
Rate for Payer: Entrust Commercial $238.45
Rate for Payer: First Choice Health Commercial $238.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $238.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $153.11
Rate for Payer: HealthUtah PPO $251.00
Rate for Payer: Idaho Integrated Healthcare Commercial $243.47
Rate for Payer: Multiplan Medicare/VA $145.45
Rate for Payer: One Health Plan of WY PPO $245.98
Rate for Payer: PacificSource Commercial $225.90
Rate for Payer: PHCS PPO $245.98
Rate for Payer: Three Rivers PPO $188.25
Rate for Payer: TriWest Veterans Administration $153.11
Rate for Payer: United Healthcare Commercial $239.70
Rate for Payer: United Healthcare Medicare $153.11
Rate for Payer: WINHealth Partners Commercial $238.45
Rate for Payer: Wise Provider Network Commercial $238.45
Service Code HCPCS 82542
Hospital Charge Code 3018254203
Hospital Revenue Code 301
Min. Negotiated Rate $110.68
Max. Negotiated Rate $191.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $187.18
Rate for Payer: Aetna of WY Medicare $122.24
Rate for Payer: Altius Commercial $183.36
Rate for Payer: Beech Street Commercial $187.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $185.27
Rate for Payer: Cash Price $133.70
Rate for Payer: ChoiceCare Network Commercial $185.27
Rate for Payer: Cigna of WY Commercial $187.18
Rate for Payer: Entrust Commercial $181.45
Rate for Payer: First Choice Health Commercial $181.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $181.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $116.51
Rate for Payer: HealthUtah PPO $191.00
Rate for Payer: Idaho Integrated Healthcare Commercial $185.27
Rate for Payer: Multiplan Medicare/VA $110.68
Rate for Payer: One Health Plan of WY PPO $187.18
Rate for Payer: PacificSource Commercial $171.90
Rate for Payer: PHCS PPO $187.18
Rate for Payer: Three Rivers PPO $143.25
Rate for Payer: TriWest Veterans Administration $116.51
Rate for Payer: United Healthcare Commercial $182.40
Rate for Payer: United Healthcare Medicare $116.51
Rate for Payer: WINHealth Partners Commercial $181.45
Rate for Payer: Wise Provider Network Commercial $181.45