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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
Service Code HCPCS 82542
Hospital Charge Code 3018254205
Hospital Revenue Code 301
Min. Negotiated Rate $126.33
Max. Negotiated Rate $218.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $213.64
Rate for Payer: Aetna of WY Medicare $139.52
Rate for Payer: Altius Commercial $209.28
Rate for Payer: Beech Street Commercial $213.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $211.46
Rate for Payer: Cash Price $152.60
Rate for Payer: ChoiceCare Network Commercial $211.46
Rate for Payer: Cigna of WY Commercial $213.64
Rate for Payer: Entrust Commercial $207.10
Rate for Payer: First Choice Health Commercial $207.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $207.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $132.98
Rate for Payer: HealthUtah PPO $218.00
Rate for Payer: Idaho Integrated Healthcare Commercial $211.46
Rate for Payer: Multiplan Medicare/VA $126.33
Rate for Payer: One Health Plan of WY PPO $213.64
Rate for Payer: PacificSource Commercial $196.20
Rate for Payer: PHCS PPO $213.64
Rate for Payer: Three Rivers PPO $163.50
Rate for Payer: TriWest Veterans Administration $132.98
Rate for Payer: United Healthcare Commercial $208.19
Rate for Payer: United Healthcare Medicare $132.98
Rate for Payer: WINHealth Partners Commercial $207.10
Rate for Payer: Wise Provider Network Commercial $207.10
Service Code HCPCS 82542
Hospital Charge Code 3018254205
Hospital Revenue Code 301
Min. Negotiated Rate $118.05
Max. Negotiated Rate $218.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $213.64
Rate for Payer: Aetna of WY Medicare $143.88
Rate for Payer: Altius Commercial $209.28
Rate for Payer: Beech Street Commercial $213.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $211.46
Rate for Payer: Cash Price $152.60
Rate for Payer: ChoiceCare Network Commercial $211.46
Rate for Payer: Cigna of WY Commercial $213.64
Rate for Payer: Entrust Commercial $207.10
Rate for Payer: First Choice Health Commercial $207.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $207.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $124.26
Rate for Payer: HealthUtah PPO $218.00
Rate for Payer: Idaho Integrated Healthcare Commercial $211.46
Rate for Payer: Multiplan Medicare/VA $118.05
Rate for Payer: One Health Plan of WY PPO $213.64
Rate for Payer: PacificSource Commercial $196.20
Rate for Payer: PHCS PPO $213.64
Rate for Payer: Three Rivers PPO $163.50
Rate for Payer: TriWest Veterans Administration $124.26
Rate for Payer: United Healthcare Commercial $208.19
Rate for Payer: United Healthcare Medicare $124.26
Rate for Payer: WINHealth Partners Commercial $213.64
Rate for Payer: Wise Provider Network Commercial $207.10
Service Code HCPCS 82542
Hospital Charge Code 3018254201
Hospital Revenue Code 301
Min. Negotiated Rate $126.33
Max. Negotiated Rate $218.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $213.64
Rate for Payer: Aetna of WY Medicare $139.52
Rate for Payer: Altius Commercial $209.28
Rate for Payer: Beech Street Commercial $213.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $211.46
Rate for Payer: Cash Price $152.60
Rate for Payer: ChoiceCare Network Commercial $211.46
Rate for Payer: Cigna of WY Commercial $213.64
Rate for Payer: Entrust Commercial $207.10
Rate for Payer: First Choice Health Commercial $207.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $207.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $132.98
Rate for Payer: HealthUtah PPO $218.00
Rate for Payer: Idaho Integrated Healthcare Commercial $211.46
Rate for Payer: Multiplan Medicare/VA $126.33
Rate for Payer: One Health Plan of WY PPO $213.64
Rate for Payer: PacificSource Commercial $196.20
Rate for Payer: PHCS PPO $213.64
Rate for Payer: Three Rivers PPO $163.50
Rate for Payer: TriWest Veterans Administration $132.98
Rate for Payer: United Healthcare Commercial $208.19
Rate for Payer: United Healthcare Medicare $132.98
Rate for Payer: WINHealth Partners Commercial $207.10
Rate for Payer: Wise Provider Network Commercial $207.10
Service Code HCPCS 82542
Hospital Charge Code 3018254201
Hospital Revenue Code 301
Min. Negotiated Rate $118.05
Max. Negotiated Rate $218.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $213.64
Rate for Payer: Aetna of WY Medicare $143.88
Rate for Payer: Altius Commercial $209.28
Rate for Payer: Beech Street Commercial $213.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $211.46
Rate for Payer: Cash Price $152.60
Rate for Payer: ChoiceCare Network Commercial $211.46
Rate for Payer: Cigna of WY Commercial $213.64
Rate for Payer: Entrust Commercial $207.10
Rate for Payer: First Choice Health Commercial $207.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $207.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $124.26
Rate for Payer: HealthUtah PPO $218.00
Rate for Payer: Idaho Integrated Healthcare Commercial $211.46
Rate for Payer: Multiplan Medicare/VA $118.05
Rate for Payer: One Health Plan of WY PPO $213.64
Rate for Payer: PacificSource Commercial $196.20
Rate for Payer: PHCS PPO $213.64
Rate for Payer: Three Rivers PPO $163.50
Rate for Payer: TriWest Veterans Administration $124.26
Rate for Payer: United Healthcare Commercial $208.19
Rate for Payer: United Healthcare Medicare $124.26
Rate for Payer: WINHealth Partners Commercial $213.64
Rate for Payer: Wise Provider Network Commercial $207.10
Service Code HCPCS 82542
Hospital Charge Code 3018254208
Hospital Revenue Code 301
Min. Negotiated Rate $177.07
Max. Negotiated Rate $327.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $320.46
Rate for Payer: Aetna of WY Medicare $215.82
Rate for Payer: Altius Commercial $313.92
Rate for Payer: Beech Street Commercial $320.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $317.19
Rate for Payer: Cash Price $228.90
Rate for Payer: ChoiceCare Network Commercial $317.19
Rate for Payer: Cigna of WY Commercial $320.46
Rate for Payer: Entrust Commercial $310.65
Rate for Payer: First Choice Health Commercial $310.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $310.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $186.39
Rate for Payer: HealthUtah PPO $327.00
Rate for Payer: Idaho Integrated Healthcare Commercial $317.19
Rate for Payer: Multiplan Medicare/VA $177.07
Rate for Payer: One Health Plan of WY PPO $320.46
Rate for Payer: PacificSource Commercial $294.30
Rate for Payer: PHCS PPO $320.46
Rate for Payer: Three Rivers PPO $245.25
Rate for Payer: TriWest Veterans Administration $186.39
Rate for Payer: United Healthcare Commercial $312.28
Rate for Payer: United Healthcare Medicare $186.39
Rate for Payer: WINHealth Partners Commercial $320.46
Rate for Payer: Wise Provider Network Commercial $310.65
Service Code HCPCS 82542
Hospital Charge Code 3018254208
Hospital Revenue Code 301
Min. Negotiated Rate $189.50
Max. Negotiated Rate $327.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $320.46
Rate for Payer: Aetna of WY Medicare $209.28
Rate for Payer: Altius Commercial $313.92
Rate for Payer: Beech Street Commercial $320.46
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $317.19
Rate for Payer: Cash Price $228.90
Rate for Payer: ChoiceCare Network Commercial $317.19
Rate for Payer: Cigna of WY Commercial $320.46
Rate for Payer: Entrust Commercial $310.65
Rate for Payer: First Choice Health Commercial $310.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $310.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $199.47
Rate for Payer: HealthUtah PPO $327.00
Rate for Payer: Idaho Integrated Healthcare Commercial $317.19
Rate for Payer: Multiplan Medicare/VA $189.50
Rate for Payer: One Health Plan of WY PPO $320.46
Rate for Payer: PacificSource Commercial $294.30
Rate for Payer: PHCS PPO $320.46
Rate for Payer: Three Rivers PPO $245.25
Rate for Payer: TriWest Veterans Administration $199.47
Rate for Payer: United Healthcare Commercial $312.28
Rate for Payer: United Healthcare Medicare $199.47
Rate for Payer: WINHealth Partners Commercial $310.65
Rate for Payer: Wise Provider Network Commercial $310.65
Service Code HCPCS 86157
Hospital Charge Code 3028615701
Hospital Revenue Code 302
Min. Negotiated Rate $58.48
Max. Negotiated Rate $108.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $105.84
Rate for Payer: Aetna of WY Medicare $71.28
Rate for Payer: Altius Commercial $103.68
Rate for Payer: Beech Street Commercial $105.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $104.76
Rate for Payer: Cash Price $75.60
Rate for Payer: ChoiceCare Network Commercial $104.76
Rate for Payer: Cigna of WY Commercial $105.84
Rate for Payer: Entrust Commercial $102.60
Rate for Payer: First Choice Health Commercial $102.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $102.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $61.56
Rate for Payer: HealthUtah PPO $108.00
Rate for Payer: Idaho Integrated Healthcare Commercial $104.76
Rate for Payer: Multiplan Medicare/VA $58.48
Rate for Payer: One Health Plan of WY PPO $105.84
Rate for Payer: PacificSource Commercial $97.20
Rate for Payer: PHCS PPO $105.84
Rate for Payer: Three Rivers PPO $81.00
Rate for Payer: TriWest Veterans Administration $61.56
Rate for Payer: United Healthcare Commercial $103.14
Rate for Payer: United Healthcare Medicare $61.56
Rate for Payer: WINHealth Partners Commercial $105.84
Rate for Payer: Wise Provider Network Commercial $102.60
Service Code HCPCS 86157
Hospital Charge Code 3028615701
Hospital Revenue Code 302
Min. Negotiated Rate $62.59
Max. Negotiated Rate $108.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $105.84
Rate for Payer: Aetna of WY Medicare $69.12
Rate for Payer: Altius Commercial $103.68
Rate for Payer: Beech Street Commercial $105.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $104.76
Rate for Payer: Cash Price $75.60
Rate for Payer: ChoiceCare Network Commercial $104.76
Rate for Payer: Cigna of WY Commercial $105.84
Rate for Payer: Entrust Commercial $102.60
Rate for Payer: First Choice Health Commercial $102.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $102.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $65.88
Rate for Payer: HealthUtah PPO $108.00
Rate for Payer: Idaho Integrated Healthcare Commercial $104.76
Rate for Payer: Multiplan Medicare/VA $62.59
Rate for Payer: One Health Plan of WY PPO $105.84
Rate for Payer: PacificSource Commercial $97.20
Rate for Payer: PHCS PPO $105.84
Rate for Payer: Three Rivers PPO $81.00
Rate for Payer: TriWest Veterans Administration $65.88
Rate for Payer: United Healthcare Commercial $103.14
Rate for Payer: United Healthcare Medicare $65.88
Rate for Payer: WINHealth Partners Commercial $102.60
Rate for Payer: Wise Provider Network Commercial $102.60
Hospital Charge Code 3600000029
Hospital Revenue Code 360
Min. Negotiated Rate $516.33
Max. Negotiated Rate $891.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $873.18
Rate for Payer: Aetna of WY Medicare $570.24
Rate for Payer: Altius Commercial $855.36
Rate for Payer: Beech Street Commercial $873.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $864.27
Rate for Payer: Cash Price $623.70
Rate for Payer: ChoiceCare Network Commercial $864.27
Rate for Payer: Cigna of WY Commercial $873.18
Rate for Payer: Entrust Commercial $846.45
Rate for Payer: First Choice Health Commercial $846.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $846.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $543.51
Rate for Payer: HealthUtah PPO $891.00
Rate for Payer: Idaho Integrated Healthcare Commercial $864.27
Rate for Payer: Multiplan Medicare/VA $516.33
Rate for Payer: One Health Plan of WY PPO $873.18
Rate for Payer: PacificSource Commercial $801.90
Rate for Payer: PHCS PPO $873.18
Rate for Payer: Three Rivers PPO $668.25
Rate for Payer: TriWest Veterans Administration $543.51
Rate for Payer: United Healthcare Commercial $850.90
Rate for Payer: United Healthcare Medicare $543.51
Rate for Payer: WINHealth Partners Commercial $846.45
Rate for Payer: Wise Provider Network Commercial $846.45
Hospital Charge Code 3600000029
Hospital Revenue Code 360
Min. Negotiated Rate $482.48
Max. Negotiated Rate $891.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $873.18
Rate for Payer: Aetna of WY Medicare $588.06
Rate for Payer: Altius Commercial $855.36
Rate for Payer: Beech Street Commercial $873.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $864.27
Rate for Payer: Cash Price $623.70
Rate for Payer: ChoiceCare Network Commercial $864.27
Rate for Payer: Cigna of WY Commercial $873.18
Rate for Payer: Entrust Commercial $846.45
Rate for Payer: First Choice Health Commercial $846.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $846.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $507.87
Rate for Payer: HealthUtah PPO $891.00
Rate for Payer: Idaho Integrated Healthcare Commercial $864.27
Rate for Payer: Multiplan Medicare/VA $482.48
Rate for Payer: One Health Plan of WY PPO $873.18
Rate for Payer: PacificSource Commercial $801.90
Rate for Payer: PHCS PPO $873.18
Rate for Payer: Three Rivers PPO $668.25
Rate for Payer: TriWest Veterans Administration $507.87
Rate for Payer: United Healthcare Commercial $850.90
Rate for Payer: United Healthcare Medicare $507.87
Rate for Payer: WINHealth Partners Commercial $873.18
Rate for Payer: Wise Provider Network Commercial $846.45
Hospital Charge Code 3600000036
Hospital Revenue Code 360
Min. Negotiated Rate $270.63
Max. Negotiated Rate $467.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $457.66
Rate for Payer: Aetna of WY Medicare $298.88
Rate for Payer: Altius Commercial $448.32
Rate for Payer: Beech Street Commercial $457.66
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $452.99
Rate for Payer: Cash Price $326.90
Rate for Payer: ChoiceCare Network Commercial $452.99
Rate for Payer: Cigna of WY Commercial $457.66
Rate for Payer: Entrust Commercial $443.65
Rate for Payer: First Choice Health Commercial $443.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $443.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $284.87
Rate for Payer: HealthUtah PPO $467.00
Rate for Payer: Idaho Integrated Healthcare Commercial $452.99
Rate for Payer: Multiplan Medicare/VA $270.63
Rate for Payer: One Health Plan of WY PPO $457.66
Rate for Payer: PacificSource Commercial $420.30
Rate for Payer: PHCS PPO $457.66
Rate for Payer: Three Rivers PPO $350.25
Rate for Payer: TriWest Veterans Administration $284.87
Rate for Payer: United Healthcare Commercial $445.98
Rate for Payer: United Healthcare Medicare $284.87
Rate for Payer: WINHealth Partners Commercial $443.65
Rate for Payer: Wise Provider Network Commercial $443.65
Hospital Charge Code 3600000036
Hospital Revenue Code 360
Min. Negotiated Rate $252.88
Max. Negotiated Rate $467.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $457.66
Rate for Payer: Aetna of WY Medicare $308.22
Rate for Payer: Altius Commercial $448.32
Rate for Payer: Beech Street Commercial $457.66
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $452.99
Rate for Payer: Cash Price $326.90
Rate for Payer: ChoiceCare Network Commercial $452.99
Rate for Payer: Cigna of WY Commercial $457.66
Rate for Payer: Entrust Commercial $443.65
Rate for Payer: First Choice Health Commercial $443.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $443.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $266.19
Rate for Payer: HealthUtah PPO $467.00
Rate for Payer: Idaho Integrated Healthcare Commercial $452.99
Rate for Payer: Multiplan Medicare/VA $252.88
Rate for Payer: One Health Plan of WY PPO $457.66
Rate for Payer: PacificSource Commercial $420.30
Rate for Payer: PHCS PPO $457.66
Rate for Payer: Three Rivers PPO $350.25
Rate for Payer: TriWest Veterans Administration $266.19
Rate for Payer: United Healthcare Commercial $445.98
Rate for Payer: United Healthcare Medicare $266.19
Rate for Payer: WINHealth Partners Commercial $457.66
Rate for Payer: Wise Provider Network Commercial $443.65
Service Code HCPCS 57454
Hospital Charge Code 5105745401
Hospital Revenue Code 510
Min. Negotiated Rate $61.43
Max. Negotiated Rate $106.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $103.88
Rate for Payer: Aetna of WY Medicare $67.84
Rate for Payer: Altius Commercial $101.76
Rate for Payer: Beech Street Commercial $103.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $102.82
Rate for Payer: Cash Price $74.20
Rate for Payer: ChoiceCare Network Commercial $102.82
Rate for Payer: Cigna of WY Commercial $103.88
Rate for Payer: Entrust Commercial $100.70
Rate for Payer: First Choice Health Commercial $100.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $100.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $64.66
Rate for Payer: HealthUtah PPO $106.00
Rate for Payer: Idaho Integrated Healthcare Commercial $102.82
Rate for Payer: Multiplan Medicare/VA $61.43
Rate for Payer: One Health Plan of WY PPO $103.88
Rate for Payer: PacificSource Commercial $95.40
Rate for Payer: PHCS PPO $103.88
Rate for Payer: Three Rivers PPO $79.50
Rate for Payer: TriWest Veterans Administration $64.66
Rate for Payer: United Healthcare Commercial $101.23
Rate for Payer: United Healthcare Medicare $64.66
Rate for Payer: WINHealth Partners Commercial $100.70
Rate for Payer: Wise Provider Network Commercial $100.70
Service Code HCPCS 57454
Hospital Charge Code 5105745401
Hospital Revenue Code 510
Min. Negotiated Rate $57.40
Max. Negotiated Rate $106.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $103.88
Rate for Payer: Aetna of WY Medicare $69.96
Rate for Payer: Altius Commercial $101.76
Rate for Payer: Beech Street Commercial $103.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $102.82
Rate for Payer: Cash Price $74.20
Rate for Payer: ChoiceCare Network Commercial $102.82
Rate for Payer: Cigna of WY Commercial $103.88
Rate for Payer: Entrust Commercial $100.70
Rate for Payer: First Choice Health Commercial $100.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $100.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $60.42
Rate for Payer: HealthUtah PPO $106.00
Rate for Payer: Idaho Integrated Healthcare Commercial $102.82
Rate for Payer: Multiplan Medicare/VA $57.40
Rate for Payer: One Health Plan of WY PPO $103.88
Rate for Payer: PacificSource Commercial $95.40
Rate for Payer: PHCS PPO $103.88
Rate for Payer: Three Rivers PPO $79.50
Rate for Payer: TriWest Veterans Administration $60.42
Rate for Payer: United Healthcare Commercial $101.23
Rate for Payer: United Healthcare Medicare $60.42
Rate for Payer: WINHealth Partners Commercial $103.88
Rate for Payer: Wise Provider Network Commercial $100.70
Service Code HCPCS 85242
Hospital Charge Code 3058524201
Hospital Revenue Code 305
Min. Negotiated Rate $249.63
Max. Negotiated Rate $461.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $451.78
Rate for Payer: Aetna of WY Medicare $304.26
Rate for Payer: Altius Commercial $442.56
Rate for Payer: Beech Street Commercial $451.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $447.17
Rate for Payer: Cash Price $322.70
Rate for Payer: ChoiceCare Network Commercial $447.17
Rate for Payer: Cigna of WY Commercial $451.78
Rate for Payer: Entrust Commercial $437.95
Rate for Payer: First Choice Health Commercial $437.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $437.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $262.77
Rate for Payer: HealthUtah PPO $461.00
Rate for Payer: Idaho Integrated Healthcare Commercial $447.17
Rate for Payer: Multiplan Medicare/VA $249.63
Rate for Payer: One Health Plan of WY PPO $451.78
Rate for Payer: PacificSource Commercial $414.90
Rate for Payer: PHCS PPO $451.78
Rate for Payer: Three Rivers PPO $345.75
Rate for Payer: TriWest Veterans Administration $262.77
Rate for Payer: United Healthcare Commercial $440.26
Rate for Payer: United Healthcare Medicare $262.77
Rate for Payer: WINHealth Partners Commercial $451.78
Rate for Payer: Wise Provider Network Commercial $437.95
Service Code HCPCS 85242
Hospital Charge Code 3058524201
Hospital Revenue Code 305
Min. Negotiated Rate $267.15
Max. Negotiated Rate $461.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $451.78
Rate for Payer: Aetna of WY Medicare $295.04
Rate for Payer: Altius Commercial $442.56
Rate for Payer: Beech Street Commercial $451.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $447.17
Rate for Payer: Cash Price $322.70
Rate for Payer: ChoiceCare Network Commercial $447.17
Rate for Payer: Cigna of WY Commercial $451.78
Rate for Payer: Entrust Commercial $437.95
Rate for Payer: First Choice Health Commercial $437.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $437.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $281.21
Rate for Payer: HealthUtah PPO $461.00
Rate for Payer: Idaho Integrated Healthcare Commercial $447.17
Rate for Payer: Multiplan Medicare/VA $267.15
Rate for Payer: One Health Plan of WY PPO $451.78
Rate for Payer: PacificSource Commercial $414.90
Rate for Payer: PHCS PPO $451.78
Rate for Payer: Three Rivers PPO $345.75
Rate for Payer: TriWest Veterans Administration $281.21
Rate for Payer: United Healthcare Commercial $440.26
Rate for Payer: United Healthcare Medicare $281.21
Rate for Payer: WINHealth Partners Commercial $437.95
Rate for Payer: Wise Provider Network Commercial $437.95
Service Code HCPCS 86923
Hospital Charge Code 3008692301
Hospital Revenue Code 300
Min. Negotiated Rate $294.97
Max. Negotiated Rate $509.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $498.82
Rate for Payer: Aetna of WY Medicare $325.76
Rate for Payer: Altius Commercial $488.64
Rate for Payer: Beech Street Commercial $498.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $493.73
Rate for Payer: Cash Price $356.30
Rate for Payer: ChoiceCare Network Commercial $493.73
Rate for Payer: Cigna of WY Commercial $498.82
Rate for Payer: Entrust Commercial $483.55
Rate for Payer: First Choice Health Commercial $483.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $483.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $310.49
Rate for Payer: HealthUtah PPO $509.00
Rate for Payer: Idaho Integrated Healthcare Commercial $493.73
Rate for Payer: Multiplan Medicare/VA $294.97
Rate for Payer: One Health Plan of WY PPO $498.82
Rate for Payer: PacificSource Commercial $458.10
Rate for Payer: PHCS PPO $498.82
Rate for Payer: Three Rivers PPO $381.75
Rate for Payer: TriWest Veterans Administration $310.49
Rate for Payer: United Healthcare Commercial $486.10
Rate for Payer: United Healthcare Medicare $310.49
Rate for Payer: WINHealth Partners Commercial $483.55
Rate for Payer: Wise Provider Network Commercial $483.55
Service Code HCPCS 86923
Hospital Charge Code 3008692301
Hospital Revenue Code 300
Min. Negotiated Rate $275.62
Max. Negotiated Rate $509.00
Rate for Payer: United Healthcare Commercial $486.10
Rate for Payer: Aetna of WY Commercial/Medical Rental $498.82
Rate for Payer: Aetna of WY Medicare $335.94
Rate for Payer: Altius Commercial $488.64
Rate for Payer: Beech Street Commercial $498.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $493.73
Rate for Payer: Cash Price $356.30
Rate for Payer: ChoiceCare Network Commercial $493.73
Rate for Payer: Cigna of WY Commercial $498.82
Rate for Payer: Entrust Commercial $483.55
Rate for Payer: First Choice Health Commercial $483.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $483.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $290.13
Rate for Payer: HealthUtah PPO $509.00
Rate for Payer: Idaho Integrated Healthcare Commercial $493.73
Rate for Payer: Multiplan Medicare/VA $275.62
Rate for Payer: One Health Plan of WY PPO $498.82
Rate for Payer: PacificSource Commercial $458.10
Rate for Payer: PHCS PPO $498.82
Rate for Payer: Three Rivers PPO $381.75
Rate for Payer: TriWest Veterans Administration $290.13
Rate for Payer: United Healthcare Medicare $290.13
Rate for Payer: WINHealth Partners Commercial $498.82
Rate for Payer: Wise Provider Network Commercial $483.55
Service Code HCPCS 86922
Hospital Charge Code 3008692201
Hospital Revenue Code 300
Min. Negotiated Rate $308.66
Max. Negotiated Rate $570.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $558.60
Rate for Payer: Aetna of WY Medicare $376.20
Rate for Payer: Altius Commercial $547.20
Rate for Payer: Beech Street Commercial $558.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $552.90
Rate for Payer: Cash Price $399.00
Rate for Payer: ChoiceCare Network Commercial $552.90
Rate for Payer: Cigna of WY Commercial $558.60
Rate for Payer: Entrust Commercial $541.50
Rate for Payer: First Choice Health Commercial $541.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $541.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $324.90
Rate for Payer: HealthUtah PPO $570.00
Rate for Payer: Idaho Integrated Healthcare Commercial $552.90
Rate for Payer: Multiplan Medicare/VA $308.66
Rate for Payer: One Health Plan of WY PPO $558.60
Rate for Payer: PacificSource Commercial $513.00
Rate for Payer: PHCS PPO $558.60
Rate for Payer: Three Rivers PPO $427.50
Rate for Payer: TriWest Veterans Administration $324.90
Rate for Payer: United Healthcare Commercial $544.35
Rate for Payer: United Healthcare Medicare $324.90
Rate for Payer: WINHealth Partners Commercial $558.60
Rate for Payer: Wise Provider Network Commercial $541.50
Service Code HCPCS 86922
Hospital Charge Code 3008692201
Hospital Revenue Code 300
Min. Negotiated Rate $330.32
Max. Negotiated Rate $570.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $558.60
Rate for Payer: Aetna of WY Medicare $364.80
Rate for Payer: Altius Commercial $547.20
Rate for Payer: Beech Street Commercial $558.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $552.90
Rate for Payer: Cash Price $399.00
Rate for Payer: ChoiceCare Network Commercial $552.90
Rate for Payer: Cigna of WY Commercial $558.60
Rate for Payer: Entrust Commercial $541.50
Rate for Payer: First Choice Health Commercial $541.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $541.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $347.70
Rate for Payer: HealthUtah PPO $570.00
Rate for Payer: Idaho Integrated Healthcare Commercial $552.90
Rate for Payer: Multiplan Medicare/VA $330.32
Rate for Payer: One Health Plan of WY PPO $558.60
Rate for Payer: PacificSource Commercial $513.00
Rate for Payer: PHCS PPO $558.60
Rate for Payer: Three Rivers PPO $427.50
Rate for Payer: TriWest Veterans Administration $347.70
Rate for Payer: United Healthcare Commercial $544.35
Rate for Payer: United Healthcare Medicare $347.70
Rate for Payer: WINHealth Partners Commercial $541.50
Rate for Payer: Wise Provider Network Commercial $541.50
Service Code HCPCS 86160
Hospital Charge Code 3028616003
Hospital Revenue Code 302
Min. Negotiated Rate $60.85
Max. Negotiated Rate $105.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $102.90
Rate for Payer: Aetna of WY Medicare $67.20
Rate for Payer: Altius Commercial $100.80
Rate for Payer: Beech Street Commercial $102.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $101.85
Rate for Payer: Cash Price $73.50
Rate for Payer: ChoiceCare Network Commercial $101.85
Rate for Payer: Cigna of WY Commercial $102.90
Rate for Payer: Entrust Commercial $99.75
Rate for Payer: First Choice Health Commercial $99.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $99.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $64.05
Rate for Payer: HealthUtah PPO $105.00
Rate for Payer: Idaho Integrated Healthcare Commercial $101.85
Rate for Payer: Multiplan Medicare/VA $60.85
Rate for Payer: One Health Plan of WY PPO $102.90
Rate for Payer: PacificSource Commercial $94.50
Rate for Payer: PHCS PPO $102.90
Rate for Payer: Three Rivers PPO $78.75
Rate for Payer: TriWest Veterans Administration $64.05
Rate for Payer: United Healthcare Commercial $100.28
Rate for Payer: United Healthcare Medicare $64.05
Rate for Payer: WINHealth Partners Commercial $99.75
Rate for Payer: Wise Provider Network Commercial $99.75
Service Code HCPCS 86160
Hospital Charge Code 3028616003
Hospital Revenue Code 302
Min. Negotiated Rate $56.86
Max. Negotiated Rate $105.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $102.90
Rate for Payer: Aetna of WY Medicare $69.30
Rate for Payer: Altius Commercial $100.80
Rate for Payer: Beech Street Commercial $102.90
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $101.85
Rate for Payer: Cash Price $73.50
Rate for Payer: ChoiceCare Network Commercial $101.85
Rate for Payer: Cigna of WY Commercial $102.90
Rate for Payer: Entrust Commercial $99.75
Rate for Payer: First Choice Health Commercial $99.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $99.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $59.85
Rate for Payer: HealthUtah PPO $105.00
Rate for Payer: Idaho Integrated Healthcare Commercial $101.85
Rate for Payer: Multiplan Medicare/VA $56.86
Rate for Payer: One Health Plan of WY PPO $102.90
Rate for Payer: PacificSource Commercial $94.50
Rate for Payer: PHCS PPO $102.90
Rate for Payer: Three Rivers PPO $78.75
Rate for Payer: TriWest Veterans Administration $59.85
Rate for Payer: United Healthcare Commercial $100.28
Rate for Payer: United Healthcare Medicare $59.85
Rate for Payer: WINHealth Partners Commercial $102.90
Rate for Payer: Wise Provider Network Commercial $99.75
Service Code HCPCS 86160
Hospital Charge Code 3028616002
Hospital Revenue Code 302
Min. Negotiated Rate $94.76
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Aetna of WY Medicare $115.50
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $169.75
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $99.75
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $94.76
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $99.75
Rate for Payer: United Healthcare Commercial $167.12
Rate for Payer: United Healthcare Medicare $99.75
Rate for Payer: WINHealth Partners Commercial $171.50
Rate for Payer: Wise Provider Network Commercial $166.25
Service Code HCPCS 86160
Hospital Charge Code 3028616002
Hospital Revenue Code 302
Min. Negotiated Rate $101.41
Max. Negotiated Rate $175.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.50
Rate for Payer: Aetna of WY Medicare $112.00
Rate for Payer: Altius Commercial $168.00
Rate for Payer: Beech Street Commercial $171.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $169.75
Rate for Payer: Cash Price $122.50
Rate for Payer: ChoiceCare Network Commercial $169.75
Rate for Payer: Cigna of WY Commercial $171.50
Rate for Payer: Entrust Commercial $166.25
Rate for Payer: First Choice Health Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $106.75
Rate for Payer: HealthUtah PPO $175.00
Rate for Payer: Idaho Integrated Healthcare Commercial $169.75
Rate for Payer: Multiplan Medicare/VA $101.41
Rate for Payer: One Health Plan of WY PPO $171.50
Rate for Payer: PacificSource Commercial $157.50
Rate for Payer: PHCS PPO $171.50
Rate for Payer: Three Rivers PPO $131.25
Rate for Payer: TriWest Veterans Administration $106.75
Rate for Payer: United Healthcare Commercial $167.12
Rate for Payer: United Healthcare Medicare $106.75
Rate for Payer: WINHealth Partners Commercial $166.25
Rate for Payer: Wise Provider Network Commercial $166.25