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Service Code NDC 5026806115
Hospital Revenue Code 250
Min. Negotiated Rate $0.65
Max. Negotiated Rate $1.18
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.16
Rate for Payer: Aetna of WY Medicare $0.78
Rate for Payer: Altius Auto/Workers Compensation $1.13
Rate for Payer: Altius Commercial $1.13
Rate for Payer: Beech Street Commercial $1.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.97
Rate for Payer: Cash Price $0.82
Rate for Payer: ChoiceCare Network Commercial $1.14
Rate for Payer: Cigna of WY Commercial $1.16
Rate for Payer: Entrust Commercial $1.12
Rate for Payer: First Choice Health Commercial $1.12
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.12
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.68
Rate for Payer: HealthUtah PPO $1.18
Rate for Payer: Idaho Integrated Healthcare Commercial $1.14
Rate for Payer: Multiplan Medicare/VA $0.65
Rate for Payer: One Health Plan of WY PPO $1.16
Rate for Payer: PacificSource Commercial $1.06
Rate for Payer: PHCS PPO $1.16
Rate for Payer: Three Rivers PPO $0.89
Rate for Payer: TriWest Veterans Administration $0.68
Rate for Payer: United Healthcare Commercial $1.03
Rate for Payer: United Healthcare Medicare $0.68
Rate for Payer: WINHealth Partners Commercial $1.16
Rate for Payer: Wise Provider Network Commercial $1.12
Service Code NDC 6808410811
Hospital Revenue Code 250
Min. Negotiated Rate $0.85
Max. Negotiated Rate $1.55
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.52
Rate for Payer: Aetna of WY Medicare $1.02
Rate for Payer: Altius Auto/Workers Compensation $1.49
Rate for Payer: Altius Commercial $1.49
Rate for Payer: Beech Street Commercial $1.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.27
Rate for Payer: Cash Price $1.09
Rate for Payer: ChoiceCare Network Commercial $1.50
Rate for Payer: Cigna of WY Commercial $1.52
Rate for Payer: Entrust Commercial $1.47
Rate for Payer: First Choice Health Commercial $1.47
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.47
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.90
Rate for Payer: HealthUtah PPO $1.55
Rate for Payer: Idaho Integrated Healthcare Commercial $1.50
Rate for Payer: Multiplan Medicare/VA $0.85
Rate for Payer: One Health Plan of WY PPO $1.52
Rate for Payer: PacificSource Commercial $1.40
Rate for Payer: PHCS PPO $1.52
Rate for Payer: Three Rivers PPO $1.16
Rate for Payer: TriWest Veterans Administration $0.90
Rate for Payer: United Healthcare Commercial $1.35
Rate for Payer: United Healthcare Medicare $0.90
Rate for Payer: WINHealth Partners Commercial $1.52
Rate for Payer: Wise Provider Network Commercial $1.47
Service Code NDC 5026806111
Hospital Revenue Code 250
Min. Negotiated Rate $0.74
Max. Negotiated Rate $1.18
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.16
Rate for Payer: Altius Auto/Workers Compensation $1.13
Rate for Payer: Altius Commercial $1.13
Rate for Payer: Beech Street Commercial $1.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.97
Rate for Payer: Cash Price $0.82
Rate for Payer: ChoiceCare Network Commercial $1.14
Rate for Payer: Cigna of WY Commercial $1.16
Rate for Payer: Entrust Commercial $1.12
Rate for Payer: First Choice Health Commercial $1.12
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.12
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.78
Rate for Payer: HealthUtah PPO $1.18
Rate for Payer: Idaho Integrated Healthcare Commercial $1.14
Rate for Payer: Multiplan Medicare/VA $0.74
Rate for Payer: One Health Plan of WY PPO $1.16
Rate for Payer: PacificSource Commercial $1.06
Rate for Payer: PHCS PPO $1.16
Rate for Payer: Three Rivers PPO $0.89
Rate for Payer: TriWest Veterans Administration $0.78
Rate for Payer: United Healthcare Commercial $1.03
Rate for Payer: United Healthcare Medicare $0.78
Rate for Payer: WINHealth Partners Commercial $1.12
Rate for Payer: Wise Provider Network Commercial $1.12
Service Code NDC 5026806115
Hospital Revenue Code 250
Min. Negotiated Rate $0.74
Max. Negotiated Rate $1.18
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.16
Rate for Payer: Altius Auto/Workers Compensation $1.13
Rate for Payer: Altius Commercial $1.13
Rate for Payer: Beech Street Commercial $1.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.97
Rate for Payer: Cash Price $0.82
Rate for Payer: ChoiceCare Network Commercial $1.14
Rate for Payer: Cigna of WY Commercial $1.16
Rate for Payer: Entrust Commercial $1.12
Rate for Payer: First Choice Health Commercial $1.12
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.12
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.78
Rate for Payer: HealthUtah PPO $1.18
Rate for Payer: Idaho Integrated Healthcare Commercial $1.14
Rate for Payer: Multiplan Medicare/VA $0.74
Rate for Payer: One Health Plan of WY PPO $1.16
Rate for Payer: PacificSource Commercial $1.06
Rate for Payer: PHCS PPO $1.16
Rate for Payer: Three Rivers PPO $0.89
Rate for Payer: TriWest Veterans Administration $0.78
Rate for Payer: United Healthcare Commercial $1.03
Rate for Payer: United Healthcare Medicare $0.78
Rate for Payer: WINHealth Partners Commercial $1.12
Rate for Payer: Wise Provider Network Commercial $1.12
Service Code NDC 5026806111
Hospital Revenue Code 250
Min. Negotiated Rate $0.65
Max. Negotiated Rate $1.18
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.16
Rate for Payer: Aetna of WY Medicare $0.78
Rate for Payer: Altius Auto/Workers Compensation $1.13
Rate for Payer: Altius Commercial $1.13
Rate for Payer: Beech Street Commercial $1.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.97
Rate for Payer: Cash Price $0.82
Rate for Payer: ChoiceCare Network Commercial $1.14
Rate for Payer: Cigna of WY Commercial $1.16
Rate for Payer: Entrust Commercial $1.12
Rate for Payer: First Choice Health Commercial $1.12
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.12
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.68
Rate for Payer: HealthUtah PPO $1.18
Rate for Payer: Idaho Integrated Healthcare Commercial $1.14
Rate for Payer: Multiplan Medicare/VA $0.65
Rate for Payer: One Health Plan of WY PPO $1.16
Rate for Payer: PacificSource Commercial $1.06
Rate for Payer: PHCS PPO $1.16
Rate for Payer: Three Rivers PPO $0.89
Rate for Payer: TriWest Veterans Administration $0.68
Rate for Payer: United Healthcare Commercial $1.03
Rate for Payer: United Healthcare Medicare $0.68
Rate for Payer: WINHealth Partners Commercial $1.16
Rate for Payer: Wise Provider Network Commercial $1.12
Service Code NDC 6808410811
Hospital Revenue Code 250
Min. Negotiated Rate $0.97
Max. Negotiated Rate $1.55
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.52
Rate for Payer: Altius Auto/Workers Compensation $1.49
Rate for Payer: Altius Commercial $1.49
Rate for Payer: Beech Street Commercial $1.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.27
Rate for Payer: Cash Price $1.09
Rate for Payer: ChoiceCare Network Commercial $1.50
Rate for Payer: Cigna of WY Commercial $1.52
Rate for Payer: Entrust Commercial $1.47
Rate for Payer: First Choice Health Commercial $1.47
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.47
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.02
Rate for Payer: HealthUtah PPO $1.55
Rate for Payer: Idaho Integrated Healthcare Commercial $1.50
Rate for Payer: Multiplan Medicare/VA $0.97
Rate for Payer: One Health Plan of WY PPO $1.52
Rate for Payer: PacificSource Commercial $1.40
Rate for Payer: PHCS PPO $1.52
Rate for Payer: Three Rivers PPO $1.16
Rate for Payer: TriWest Veterans Administration $1.02
Rate for Payer: United Healthcare Commercial $1.35
Rate for Payer: United Healthcare Medicare $1.02
Rate for Payer: WINHealth Partners Commercial $1.47
Rate for Payer: Wise Provider Network Commercial $1.47
Service Code HCPCS J0133
Hospital Revenue Code 636
Min. Negotiated Rate $10.58
Max. Negotiated Rate $19.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $18.82
Rate for Payer: Aetna of WY Medicare $12.67
Rate for Payer: Altius Auto/Workers Compensation $18.43
Rate for Payer: Altius Commercial $18.43
Rate for Payer: Beech Street Commercial $18.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $15.76
Rate for Payer: Cash Price $13.44
Rate for Payer: ChoiceCare Network Commercial $18.62
Rate for Payer: Cigna of WY Commercial $18.82
Rate for Payer: Entrust Commercial $18.24
Rate for Payer: First Choice Health Commercial $18.24
Rate for Payer: Government Employees Health Association (GEHA) Commercial $18.24
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.14
Rate for Payer: HealthUtah PPO $19.20
Rate for Payer: Idaho Integrated Healthcare Commercial $18.62
Rate for Payer: Multiplan Medicare/VA $10.58
Rate for Payer: One Health Plan of WY PPO $18.82
Rate for Payer: PacificSource Commercial $17.28
Rate for Payer: PHCS PPO $18.82
Rate for Payer: Three Rivers PPO $14.40
Rate for Payer: TriWest Veterans Administration $11.14
Rate for Payer: United Healthcare Commercial $16.70
Rate for Payer: United Healthcare Medicare $11.14
Rate for Payer: WINHealth Partners Commercial $18.82
Rate for Payer: Wise Provider Network Commercial $18.24
Service Code HCPCS J0133
Hospital Revenue Code 636
Min. Negotiated Rate $12.04
Max. Negotiated Rate $19.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $18.82
Rate for Payer: Altius Auto/Workers Compensation $18.43
Rate for Payer: Altius Commercial $18.43
Rate for Payer: Beech Street Commercial $18.82
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $15.76
Rate for Payer: Cash Price $13.44
Rate for Payer: ChoiceCare Network Commercial $18.62
Rate for Payer: Cigna of WY Commercial $18.82
Rate for Payer: Entrust Commercial $18.24
Rate for Payer: First Choice Health Commercial $18.24
Rate for Payer: Government Employees Health Association (GEHA) Commercial $18.24
Rate for Payer: Government Employees Health Association (GEHA) Medicare $12.67
Rate for Payer: HealthUtah PPO $19.20
Rate for Payer: Idaho Integrated Healthcare Commercial $18.62
Rate for Payer: Multiplan Medicare/VA $12.04
Rate for Payer: One Health Plan of WY PPO $18.82
Rate for Payer: PacificSource Commercial $17.28
Rate for Payer: PHCS PPO $18.82
Rate for Payer: Three Rivers PPO $14.40
Rate for Payer: TriWest Veterans Administration $12.67
Rate for Payer: United Healthcare Commercial $16.70
Rate for Payer: United Healthcare Medicare $12.67
Rate for Payer: WINHealth Partners Commercial $18.24
Rate for Payer: Wise Provider Network Commercial $18.24
Hospital Charge Code 27000000S1
Hospital Revenue Code 270
Min. Negotiated Rate $9.22
Max. Negotiated Rate $14.70
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.41
Rate for Payer: Altius Auto/Workers Compensation $14.11
Rate for Payer: Altius Commercial $14.11
Rate for Payer: Beech Street Commercial $14.41
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $12.07
Rate for Payer: Cash Price $10.29
Rate for Payer: ChoiceCare Network Commercial $14.26
Rate for Payer: Cigna of WY Commercial $14.41
Rate for Payer: Entrust Commercial $13.96
Rate for Payer: First Choice Health Commercial $13.96
Rate for Payer: Government Employees Health Association (GEHA) Commercial $13.96
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.70
Rate for Payer: HealthUtah PPO $14.70
Rate for Payer: Idaho Integrated Healthcare Commercial $14.26
Rate for Payer: Multiplan Medicare/VA $9.22
Rate for Payer: One Health Plan of WY PPO $14.41
Rate for Payer: PacificSource Commercial $13.23
Rate for Payer: PHCS PPO $14.41
Rate for Payer: Three Rivers PPO $11.02
Rate for Payer: TriWest Veterans Administration $9.70
Rate for Payer: United Healthcare Commercial $12.79
Rate for Payer: United Healthcare Medicare $9.70
Rate for Payer: WINHealth Partners Commercial $13.96
Rate for Payer: Wise Provider Network Commercial $13.96
Hospital Charge Code 27000000S1
Hospital Revenue Code 270
Min. Negotiated Rate $8.10
Max. Negotiated Rate $14.70
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.41
Rate for Payer: Aetna of WY Medicare $9.70
Rate for Payer: Altius Auto/Workers Compensation $14.11
Rate for Payer: Altius Commercial $14.11
Rate for Payer: Beech Street Commercial $14.41
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $12.07
Rate for Payer: Cash Price $10.29
Rate for Payer: ChoiceCare Network Commercial $14.26
Rate for Payer: Cigna of WY Commercial $14.41
Rate for Payer: Entrust Commercial $13.96
Rate for Payer: First Choice Health Commercial $13.96
Rate for Payer: Government Employees Health Association (GEHA) Commercial $13.96
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.53
Rate for Payer: HealthUtah PPO $14.70
Rate for Payer: Idaho Integrated Healthcare Commercial $14.26
Rate for Payer: Multiplan Medicare/VA $8.10
Rate for Payer: One Health Plan of WY PPO $14.41
Rate for Payer: PacificSource Commercial $13.23
Rate for Payer: PHCS PPO $14.41
Rate for Payer: Three Rivers PPO $11.02
Rate for Payer: TriWest Veterans Administration $8.53
Rate for Payer: United Healthcare Commercial $12.79
Rate for Payer: United Healthcare Medicare $8.53
Rate for Payer: WINHealth Partners Commercial $14.41
Rate for Payer: Wise Provider Network Commercial $13.96
Service Code HCPCS 42830
Hospital Charge Code 42830
Min. Negotiated Rate $177.80
Max. Negotiated Rate $1,068.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,046.64
Rate for Payer: Aetna of WY Medicare $209.18
Rate for Payer: Beech Street Commercial $1,014.60
Rate for Payer: Cash Price $747.60
Rate for Payer: Cash Price $747.60
Rate for Payer: ChoiceCare Network Commercial $1,035.96
Rate for Payer: Cigna of WY Commercial $1,046.64
Rate for Payer: First Choice Health Commercial $961.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,014.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $209.18
Rate for Payer: HealthUtah PPO $1,068.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,035.96
Rate for Payer: Multiplan Medicare/VA $177.80
Rate for Payer: One Health Plan of WY PPO $1,046.64
Rate for Payer: PacificSource Commercial $961.20
Rate for Payer: PHCS PPO $1,014.60
Rate for Payer: Three Rivers PPO $801.00
Rate for Payer: TriWest Veterans Administration $209.18
Rate for Payer: United Healthcare Commercial $929.16
Rate for Payer: United Healthcare Medicare $209.18
Rate for Payer: WINHealth Partners Commercial $907.80
Service Code HCPCS 42831
Hospital Charge Code 42831
Min. Negotiated Rate $193.32
Max. Negotiated Rate $1,156.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,132.88
Rate for Payer: Aetna of WY Medicare $227.43
Rate for Payer: Beech Street Commercial $1,098.20
Rate for Payer: Cash Price $809.20
Rate for Payer: Cash Price $809.20
Rate for Payer: ChoiceCare Network Commercial $1,121.32
Rate for Payer: Cigna of WY Commercial $1,132.88
Rate for Payer: First Choice Health Commercial $1,040.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,098.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $227.43
Rate for Payer: HealthUtah PPO $1,156.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,121.32
Rate for Payer: Multiplan Medicare/VA $193.32
Rate for Payer: One Health Plan of WY PPO $1,132.88
Rate for Payer: PacificSource Commercial $1,040.40
Rate for Payer: PHCS PPO $1,098.20
Rate for Payer: Three Rivers PPO $867.00
Rate for Payer: TriWest Veterans Administration $227.43
Rate for Payer: United Healthcare Commercial $1,005.72
Rate for Payer: United Healthcare Medicare $227.43
Rate for Payer: WINHealth Partners Commercial $982.60
Service Code HCPCS 42836
Hospital Charge Code 42836
Min. Negotiated Rate $204.49
Max. Negotiated Rate $1,237.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,212.26
Rate for Payer: Aetna of WY Medicare $240.58
Rate for Payer: Beech Street Commercial $1,175.15
Rate for Payer: Cash Price $865.90
Rate for Payer: Cash Price $865.90
Rate for Payer: ChoiceCare Network Commercial $1,199.89
Rate for Payer: Cigna of WY Commercial $1,212.26
Rate for Payer: First Choice Health Commercial $1,113.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,175.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $240.58
Rate for Payer: HealthUtah PPO $1,237.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,199.89
Rate for Payer: Multiplan Medicare/VA $204.49
Rate for Payer: One Health Plan of WY PPO $1,212.26
Rate for Payer: PacificSource Commercial $1,113.30
Rate for Payer: PHCS PPO $1,175.15
Rate for Payer: Three Rivers PPO $927.75
Rate for Payer: TriWest Veterans Administration $240.58
Rate for Payer: United Healthcare Commercial $1,076.19
Rate for Payer: United Healthcare Medicare $240.58
Rate for Payer: WINHealth Partners Commercial $1,051.45
Service Code HCPCS 42835
Hospital Charge Code 42835
Min. Negotiated Rate $166.12
Max. Negotiated Rate $990.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $970.20
Rate for Payer: Aetna of WY Medicare $195.44
Rate for Payer: Beech Street Commercial $940.50
Rate for Payer: Cash Price $693.00
Rate for Payer: Cash Price $693.00
Rate for Payer: ChoiceCare Network Commercial $960.30
Rate for Payer: Cigna of WY Commercial $970.20
Rate for Payer: First Choice Health Commercial $891.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $940.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $195.44
Rate for Payer: HealthUtah PPO $990.00
Rate for Payer: Idaho Integrated Healthcare Commercial $960.30
Rate for Payer: Multiplan Medicare/VA $166.12
Rate for Payer: One Health Plan of WY PPO $970.20
Rate for Payer: PacificSource Commercial $891.00
Rate for Payer: PHCS PPO $940.50
Rate for Payer: Three Rivers PPO $742.50
Rate for Payer: TriWest Veterans Administration $195.44
Rate for Payer: United Healthcare Commercial $861.30
Rate for Payer: United Healthcare Medicare $195.44
Rate for Payer: WINHealth Partners Commercial $841.50
Service Code HCPCS J0153
Hospital Revenue Code 636
Min. Negotiated Rate $14.46
Max. Negotiated Rate $26.25
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.72
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.64
Rate for Payer: Aetna of WY Commercial/Medical Rental $33.48
Rate for Payer: Aetna of WY Medicare $17.32
Rate for Payer: Aetna of WY Medicare $22.55
Rate for Payer: Aetna of WY Medicare $17.27
Rate for Payer: Altius Auto/Workers Compensation $25.20
Rate for Payer: Altius Auto/Workers Compensation $25.11
Rate for Payer: Altius Auto/Workers Compensation $32.79
Rate for Payer: Altius Commercial $25.20
Rate for Payer: Altius Commercial $32.79
Rate for Payer: Altius Commercial $25.11
Rate for Payer: Beech Street Commercial $25.72
Rate for Payer: Beech Street Commercial $33.48
Rate for Payer: Beech Street Commercial $25.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.55
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.48
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $28.05
Rate for Payer: Cash Price $18.38
Rate for Payer: Cash Price $18.31
Rate for Payer: Cash Price $23.91
Rate for Payer: ChoiceCare Network Commercial $25.46
Rate for Payer: ChoiceCare Network Commercial $33.14
Rate for Payer: ChoiceCare Network Commercial $25.38
Rate for Payer: Cigna of WY Commercial $33.48
Rate for Payer: Cigna of WY Commercial $25.64
Rate for Payer: Cigna of WY Commercial $25.72
Rate for Payer: Entrust Commercial $32.45
Rate for Payer: Entrust Commercial $24.94
Rate for Payer: Entrust Commercial $24.85
Rate for Payer: First Choice Health Commercial $24.94
Rate for Payer: First Choice Health Commercial $24.85
Rate for Payer: First Choice Health Commercial $32.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $32.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.94
Rate for Payer: Government Employees Health Association (GEHA) Medicare $15.22
Rate for Payer: Government Employees Health Association (GEHA) Medicare $15.17
Rate for Payer: Government Employees Health Association (GEHA) Medicare $19.81
Rate for Payer: HealthUtah PPO $26.16
Rate for Payer: HealthUtah PPO $34.16
Rate for Payer: HealthUtah PPO $26.25
Rate for Payer: Idaho Integrated Healthcare Commercial $33.14
Rate for Payer: Idaho Integrated Healthcare Commercial $25.38
Rate for Payer: Idaho Integrated Healthcare Commercial $25.46
Rate for Payer: Multiplan Medicare/VA $14.41
Rate for Payer: Multiplan Medicare/VA $14.46
Rate for Payer: Multiplan Medicare/VA $18.82
Rate for Payer: One Health Plan of WY PPO $25.64
Rate for Payer: One Health Plan of WY PPO $33.48
Rate for Payer: One Health Plan of WY PPO $25.72
Rate for Payer: PacificSource Commercial $30.74
Rate for Payer: PacificSource Commercial $23.62
Rate for Payer: PacificSource Commercial $23.54
Rate for Payer: PHCS PPO $25.72
Rate for Payer: PHCS PPO $25.64
Rate for Payer: PHCS PPO $33.48
Rate for Payer: Three Rivers PPO $19.69
Rate for Payer: Three Rivers PPO $19.62
Rate for Payer: Three Rivers PPO $25.62
Rate for Payer: TriWest Veterans Administration $19.81
Rate for Payer: TriWest Veterans Administration $15.22
Rate for Payer: TriWest Veterans Administration $15.17
Rate for Payer: United Healthcare Commercial $22.76
Rate for Payer: United Healthcare Commercial $22.84
Rate for Payer: United Healthcare Commercial $29.72
Rate for Payer: United Healthcare Medicare $19.81
Rate for Payer: United Healthcare Medicare $15.17
Rate for Payer: United Healthcare Medicare $15.22
Rate for Payer: WINHealth Partners Commercial $33.48
Rate for Payer: WINHealth Partners Commercial $25.64
Rate for Payer: WINHealth Partners Commercial $25.72
Rate for Payer: Wise Provider Network Commercial $24.85
Rate for Payer: Wise Provider Network Commercial $32.45
Rate for Payer: Wise Provider Network Commercial $24.94
Service Code HCPCS J0153
Hospital Revenue Code 636
Min. Negotiated Rate $16.40
Max. Negotiated Rate $26.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.64
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.72
Rate for Payer: Aetna of WY Commercial/Medical Rental $33.48
Rate for Payer: Altius Auto/Workers Compensation $25.11
Rate for Payer: Altius Auto/Workers Compensation $25.20
Rate for Payer: Altius Auto/Workers Compensation $32.79
Rate for Payer: Altius Commercial $25.20
Rate for Payer: Altius Commercial $25.11
Rate for Payer: Altius Commercial $32.79
Rate for Payer: Beech Street Commercial $33.48
Rate for Payer: Beech Street Commercial $25.72
Rate for Payer: Beech Street Commercial $25.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.48
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $28.05
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.55
Rate for Payer: Cash Price $18.38
Rate for Payer: Cash Price $18.31
Rate for Payer: Cash Price $23.91
Rate for Payer: ChoiceCare Network Commercial $25.38
Rate for Payer: ChoiceCare Network Commercial $33.14
Rate for Payer: ChoiceCare Network Commercial $25.46
Rate for Payer: Cigna of WY Commercial $25.72
Rate for Payer: Cigna of WY Commercial $33.48
Rate for Payer: Cigna of WY Commercial $25.64
Rate for Payer: Entrust Commercial $32.45
Rate for Payer: Entrust Commercial $24.85
Rate for Payer: Entrust Commercial $24.94
Rate for Payer: First Choice Health Commercial $24.94
Rate for Payer: First Choice Health Commercial $32.45
Rate for Payer: First Choice Health Commercial $24.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $32.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.94
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.27
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $22.55
Rate for Payer: HealthUtah PPO $26.16
Rate for Payer: HealthUtah PPO $26.25
Rate for Payer: HealthUtah PPO $34.16
Rate for Payer: Idaho Integrated Healthcare Commercial $33.14
Rate for Payer: Idaho Integrated Healthcare Commercial $25.46
Rate for Payer: Idaho Integrated Healthcare Commercial $25.38
Rate for Payer: Multiplan Medicare/VA $21.42
Rate for Payer: Multiplan Medicare/VA $16.40
Rate for Payer: Multiplan Medicare/VA $16.46
Rate for Payer: One Health Plan of WY PPO $25.64
Rate for Payer: One Health Plan of WY PPO $25.72
Rate for Payer: One Health Plan of WY PPO $33.48
Rate for Payer: PacificSource Commercial $30.74
Rate for Payer: PacificSource Commercial $23.54
Rate for Payer: PacificSource Commercial $23.62
Rate for Payer: PHCS PPO $25.72
Rate for Payer: PHCS PPO $25.64
Rate for Payer: PHCS PPO $33.48
Rate for Payer: Three Rivers PPO $19.69
Rate for Payer: Three Rivers PPO $19.62
Rate for Payer: Three Rivers PPO $25.62
Rate for Payer: TriWest Veterans Administration $17.32
Rate for Payer: TriWest Veterans Administration $17.27
Rate for Payer: TriWest Veterans Administration $22.55
Rate for Payer: United Healthcare Commercial $22.76
Rate for Payer: United Healthcare Commercial $29.72
Rate for Payer: United Healthcare Commercial $22.84
Rate for Payer: United Healthcare Medicare $17.27
Rate for Payer: United Healthcare Medicare $22.55
Rate for Payer: United Healthcare Medicare $17.32
Rate for Payer: WINHealth Partners Commercial $24.94
Rate for Payer: WINHealth Partners Commercial $24.85
Rate for Payer: WINHealth Partners Commercial $32.45
Rate for Payer: Wise Provider Network Commercial $32.45
Rate for Payer: Wise Provider Network Commercial $24.85
Rate for Payer: Wise Provider Network Commercial $24.94
Service Code HCPCS J0153
Hospital Charge Code J0153
Min. Negotiated Rate $0.47
Max. Negotiated Rate $12.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $11.76
Rate for Payer: Aetna of WY Medicare $0.56
Rate for Payer: Beech Street Commercial $11.40
Rate for Payer: Cash Price $8.40
Rate for Payer: Cash Price $8.40
Rate for Payer: ChoiceCare Network Commercial $11.64
Rate for Payer: Cigna of WY Commercial $11.76
Rate for Payer: First Choice Health Commercial $10.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $11.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.56
Rate for Payer: HealthUtah PPO $12.00
Rate for Payer: Idaho Integrated Healthcare Commercial $11.64
Rate for Payer: Multiplan Medicare/VA $0.47
Rate for Payer: One Health Plan of WY PPO $11.76
Rate for Payer: PacificSource Commercial $10.80
Rate for Payer: PHCS PPO $11.40
Rate for Payer: Three Rivers PPO $9.00
Rate for Payer: TriWest Veterans Administration $0.56
Rate for Payer: United Healthcare Commercial $10.44
Rate for Payer: United Healthcare Medicare $0.56
Rate for Payer: WINHealth Partners Commercial $11.40
Service Code HCPCS 14301
Hospital Charge Code 14301
Min. Negotiated Rate $710.15
Max. Negotiated Rate $4,357.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,269.86
Rate for Payer: Aetna of WY Medicare $835.47
Rate for Payer: Beech Street Commercial $4,139.15
Rate for Payer: Cash Price $3,049.90
Rate for Payer: Cash Price $3,049.90
Rate for Payer: ChoiceCare Network Commercial $4,226.29
Rate for Payer: Cigna of WY Commercial $4,269.86
Rate for Payer: First Choice Health Commercial $3,921.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,139.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $835.47
Rate for Payer: HealthUtah PPO $4,357.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,226.29
Rate for Payer: Multiplan Medicare/VA $710.15
Rate for Payer: One Health Plan of WY PPO $4,269.86
Rate for Payer: PacificSource Commercial $3,921.30
Rate for Payer: PHCS PPO $4,139.15
Rate for Payer: Three Rivers PPO $3,267.75
Rate for Payer: TriWest Veterans Administration $835.47
Rate for Payer: United Healthcare Commercial $3,790.59
Rate for Payer: United Healthcare Medicare $835.47
Rate for Payer: WINHealth Partners Commercial $3,703.45
Service Code HCPCS 14301 AS
Hospital Charge Code 14301
Min. Negotiated Rate $710.15
Max. Negotiated Rate $4,357.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,269.86
Rate for Payer: Aetna of WY Medicare $835.47
Rate for Payer: Beech Street Commercial $4,139.15
Rate for Payer: Cash Price $3,049.90
Rate for Payer: Cash Price $3,049.90
Rate for Payer: ChoiceCare Network Commercial $4,226.29
Rate for Payer: Cigna of WY Commercial $4,269.86
Rate for Payer: First Choice Health Commercial $3,921.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,139.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $835.47
Rate for Payer: HealthUtah PPO $4,357.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,226.29
Rate for Payer: Multiplan Medicare/VA $710.15
Rate for Payer: One Health Plan of WY PPO $4,269.86
Rate for Payer: PacificSource Commercial $3,921.30
Rate for Payer: PHCS PPO $4,139.15
Rate for Payer: Three Rivers PPO $3,267.75
Rate for Payer: TriWest Veterans Administration $835.47
Rate for Payer: United Healthcare Commercial $3,790.59
Rate for Payer: United Healthcare Medicare $835.47
Rate for Payer: WINHealth Partners Commercial $3,703.45
Service Code HCPCS 14021
Hospital Charge Code 14021
Min. Negotiated Rate $582.12
Max. Negotiated Rate $3,542.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,471.16
Rate for Payer: Aetna of WY Medicare $684.85
Rate for Payer: Beech Street Commercial $3,364.90
Rate for Payer: Cash Price $2,479.40
Rate for Payer: Cash Price $2,479.40
Rate for Payer: ChoiceCare Network Commercial $3,435.74
Rate for Payer: Cigna of WY Commercial $3,471.16
Rate for Payer: First Choice Health Commercial $3,187.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,364.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $684.85
Rate for Payer: HealthUtah PPO $3,542.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,435.74
Rate for Payer: Multiplan Medicare/VA $582.12
Rate for Payer: One Health Plan of WY PPO $3,471.16
Rate for Payer: PacificSource Commercial $3,187.80
Rate for Payer: PHCS PPO $3,364.90
Rate for Payer: Three Rivers PPO $2,656.50
Rate for Payer: TriWest Veterans Administration $684.85
Rate for Payer: United Healthcare Commercial $3,081.54
Rate for Payer: United Healthcare Medicare $684.85
Rate for Payer: WINHealth Partners Commercial $3,010.70
Service Code HCPCS 14020
Hospital Charge Code 14020
Min. Negotiated Rate $467.19
Max. Negotiated Rate $2,802.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,745.96
Rate for Payer: Aetna of WY Medicare $549.64
Rate for Payer: Beech Street Commercial $2,661.90
Rate for Payer: Cash Price $1,961.40
Rate for Payer: Cash Price $1,961.40
Rate for Payer: ChoiceCare Network Commercial $2,717.94
Rate for Payer: Cigna of WY Commercial $2,745.96
Rate for Payer: First Choice Health Commercial $2,521.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,661.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $549.64
Rate for Payer: HealthUtah PPO $2,802.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,717.94
Rate for Payer: Multiplan Medicare/VA $467.19
Rate for Payer: One Health Plan of WY PPO $2,745.96
Rate for Payer: PacificSource Commercial $2,521.80
Rate for Payer: PHCS PPO $2,661.90
Rate for Payer: Three Rivers PPO $2,101.50
Rate for Payer: TriWest Veterans Administration $549.64
Rate for Payer: United Healthcare Commercial $2,437.74
Rate for Payer: United Healthcare Medicare $549.64
Rate for Payer: WINHealth Partners Commercial $2,381.70
Service Code HCPCS 14040
Hospital Charge Code 14040
Min. Negotiated Rate $513.17
Max. Negotiated Rate $3,113.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,050.74
Rate for Payer: Aetna of WY Medicare $603.73
Rate for Payer: Beech Street Commercial $2,957.35
Rate for Payer: Cash Price $2,179.10
Rate for Payer: Cash Price $2,179.10
Rate for Payer: ChoiceCare Network Commercial $3,019.61
Rate for Payer: Cigna of WY Commercial $3,050.74
Rate for Payer: First Choice Health Commercial $2,801.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,957.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $603.73
Rate for Payer: HealthUtah PPO $3,113.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,019.61
Rate for Payer: Multiplan Medicare/VA $513.17
Rate for Payer: One Health Plan of WY PPO $3,050.74
Rate for Payer: PacificSource Commercial $2,801.70
Rate for Payer: PHCS PPO $2,957.35
Rate for Payer: Three Rivers PPO $2,334.75
Rate for Payer: TriWest Veterans Administration $603.73
Rate for Payer: United Healthcare Commercial $2,708.31
Rate for Payer: United Healthcare Medicare $603.73
Rate for Payer: WINHealth Partners Commercial $2,646.05
Service Code HCPCS S2083
Hospital Charge Code S2083
Min. Negotiated Rate $145.50
Max. Negotiated Rate $194.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $190.12
Rate for Payer: Beech Street Commercial $184.30
Rate for Payer: Cash Price $135.80
Rate for Payer: ChoiceCare Network Commercial $188.18
Rate for Payer: Cigna of WY Commercial $190.12
Rate for Payer: First Choice Health Commercial $174.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $184.30
Rate for Payer: HealthUtah PPO $194.00
Rate for Payer: Idaho Integrated Healthcare Commercial $188.18
Rate for Payer: One Health Plan of WY PPO $190.12
Rate for Payer: PacificSource Commercial $174.60
Rate for Payer: PHCS PPO $184.30
Rate for Payer: Three Rivers PPO $145.50
Rate for Payer: United Healthcare Commercial $168.78
Rate for Payer: WINHealth Partners Commercial $184.30
Service Code NDC 5816074403
Hospital Revenue Code 250
Min. Negotiated Rate $239.83
Max. Negotiated Rate $382.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $374.85
Rate for Payer: Altius Auto/Workers Compensation $367.20
Rate for Payer: Altius Commercial $367.20
Rate for Payer: Beech Street Commercial $374.85
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $314.03
Rate for Payer: Cash Price $267.75
Rate for Payer: ChoiceCare Network Commercial $371.02
Rate for Payer: Cigna of WY Commercial $374.85
Rate for Payer: Entrust Commercial $363.38
Rate for Payer: First Choice Health Commercial $363.38
Rate for Payer: Government Employees Health Association (GEHA) Commercial $363.38
Rate for Payer: Government Employees Health Association (GEHA) Medicare $252.45
Rate for Payer: HealthUtah PPO $382.50
Rate for Payer: Idaho Integrated Healthcare Commercial $371.02
Rate for Payer: Multiplan Medicare/VA $239.83
Rate for Payer: One Health Plan of WY PPO $374.85
Rate for Payer: PacificSource Commercial $344.25
Rate for Payer: PHCS PPO $374.85
Rate for Payer: Three Rivers PPO $286.88
Rate for Payer: TriWest Veterans Administration $252.45
Rate for Payer: United Healthcare Commercial $332.78
Rate for Payer: United Healthcare Medicare $252.45
Rate for Payer: WINHealth Partners Commercial $363.38
Rate for Payer: Wise Provider Network Commercial $363.38
Service Code NDC 5816074403
Hospital Revenue Code 250
Min. Negotiated Rate $210.76
Max. Negotiated Rate $382.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $374.85
Rate for Payer: Aetna of WY Medicare $252.45
Rate for Payer: Altius Auto/Workers Compensation $367.20
Rate for Payer: Altius Commercial $367.20
Rate for Payer: Beech Street Commercial $374.85
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $314.03
Rate for Payer: Cash Price $267.75
Rate for Payer: ChoiceCare Network Commercial $371.02
Rate for Payer: Cigna of WY Commercial $374.85
Rate for Payer: Entrust Commercial $363.38
Rate for Payer: First Choice Health Commercial $363.38
Rate for Payer: Government Employees Health Association (GEHA) Commercial $363.38
Rate for Payer: Government Employees Health Association (GEHA) Medicare $221.85
Rate for Payer: HealthUtah PPO $382.50
Rate for Payer: Idaho Integrated Healthcare Commercial $371.02
Rate for Payer: Multiplan Medicare/VA $210.76
Rate for Payer: One Health Plan of WY PPO $374.85
Rate for Payer: PacificSource Commercial $344.25
Rate for Payer: PHCS PPO $374.85
Rate for Payer: Three Rivers PPO $286.88
Rate for Payer: TriWest Veterans Administration $221.85
Rate for Payer: United Healthcare Commercial $332.78
Rate for Payer: United Healthcare Medicare $221.85
Rate for Payer: WINHealth Partners Commercial $374.85
Rate for Payer: Wise Provider Network Commercial $363.38