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Charge Type Setting Price  
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $79.16
Max. Negotiated Rate $126.25
Rate for Payer: Aetna of WY Commercial/Medical Rental $123.72
Rate for Payer: Altius Auto/Workers Compensation $121.20
Rate for Payer: Altius Commercial $121.20
Rate for Payer: Beech Street Commercial $123.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $103.65
Rate for Payer: Cash Price $88.37
Rate for Payer: ChoiceCare Network Commercial $122.46
Rate for Payer: Cigna of WY Commercial $123.72
Rate for Payer: Entrust Commercial $119.94
Rate for Payer: First Choice Health Commercial $119.94
Rate for Payer: Government Employees Health Association (GEHA) Commercial $119.94
Rate for Payer: Government Employees Health Association (GEHA) Medicare $83.32
Rate for Payer: HealthUtah PPO $126.25
Rate for Payer: Idaho Integrated Healthcare Commercial $122.46
Rate for Payer: Multiplan Medicare/VA $79.16
Rate for Payer: One Health Plan of WY PPO $123.72
Rate for Payer: PacificSource Commercial $113.62
Rate for Payer: PHCS PPO $123.72
Rate for Payer: Three Rivers PPO $94.69
Rate for Payer: TriWest Veterans Administration $83.32
Rate for Payer: United Healthcare Commercial $109.84
Rate for Payer: United Healthcare Medicare $83.32
Rate for Payer: WINHealth Partners Commercial $119.94
Rate for Payer: Wise Provider Network Commercial $119.94
Service Code HCPCS J2270
Hospital Revenue Code 636
Min. Negotiated Rate $15.39
Max. Negotiated Rate $24.55
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.06
Rate for Payer: Altius Auto/Workers Compensation $23.57
Rate for Payer: Altius Commercial $23.57
Rate for Payer: Beech Street Commercial $24.06
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.16
Rate for Payer: Cash Price $17.19
Rate for Payer: ChoiceCare Network Commercial $23.81
Rate for Payer: Cigna of WY Commercial $24.06
Rate for Payer: Entrust Commercial $23.32
Rate for Payer: First Choice Health Commercial $23.32
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.20
Rate for Payer: HealthUtah PPO $24.55
Rate for Payer: Idaho Integrated Healthcare Commercial $23.81
Rate for Payer: Multiplan Medicare/VA $15.39
Rate for Payer: One Health Plan of WY PPO $24.06
Rate for Payer: PacificSource Commercial $22.10
Rate for Payer: PHCS PPO $24.06
Rate for Payer: Three Rivers PPO $18.41
Rate for Payer: TriWest Veterans Administration $16.20
Rate for Payer: United Healthcare Commercial $21.36
Rate for Payer: United Healthcare Medicare $16.20
Rate for Payer: WINHealth Partners Commercial $23.32
Rate for Payer: Wise Provider Network Commercial $23.32
Service Code HCPCS J2270
Hospital Revenue Code 636
Min. Negotiated Rate $13.53
Max. Negotiated Rate $24.55
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.06
Rate for Payer: Aetna of WY Medicare $16.20
Rate for Payer: Altius Auto/Workers Compensation $23.57
Rate for Payer: Altius Commercial $23.57
Rate for Payer: Beech Street Commercial $24.06
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.16
Rate for Payer: Cash Price $17.19
Rate for Payer: ChoiceCare Network Commercial $23.81
Rate for Payer: Cigna of WY Commercial $24.06
Rate for Payer: Entrust Commercial $23.32
Rate for Payer: First Choice Health Commercial $23.32
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $14.24
Rate for Payer: HealthUtah PPO $24.55
Rate for Payer: Idaho Integrated Healthcare Commercial $23.81
Rate for Payer: Multiplan Medicare/VA $13.53
Rate for Payer: One Health Plan of WY PPO $24.06
Rate for Payer: PacificSource Commercial $22.10
Rate for Payer: PHCS PPO $24.06
Rate for Payer: Three Rivers PPO $18.41
Rate for Payer: TriWest Veterans Administration $14.24
Rate for Payer: United Healthcare Commercial $21.36
Rate for Payer: United Healthcare Medicare $14.24
Rate for Payer: WINHealth Partners Commercial $24.06
Rate for Payer: Wise Provider Network Commercial $23.32
Service Code HCPCS J2270
Hospital Revenue Code 636
Min. Negotiated Rate $14.19
Max. Negotiated Rate $25.76
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.24
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.49
Rate for Payer: Aetna of WY Medicare $17.00
Rate for Payer: Aetna of WY Medicare $16.49
Rate for Payer: Altius Auto/Workers Compensation $23.99
Rate for Payer: Altius Auto/Workers Compensation $24.73
Rate for Payer: Altius Commercial $24.73
Rate for Payer: Altius Commercial $23.99
Rate for Payer: Beech Street Commercial $24.49
Rate for Payer: Beech Street Commercial $25.24
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.15
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.52
Rate for Payer: Cash Price $17.49
Rate for Payer: Cash Price $18.03
Rate for Payer: ChoiceCare Network Commercial $24.99
Rate for Payer: ChoiceCare Network Commercial $24.24
Rate for Payer: Cigna of WY Commercial $24.49
Rate for Payer: Cigna of WY Commercial $25.24
Rate for Payer: Entrust Commercial $24.47
Rate for Payer: Entrust Commercial $23.74
Rate for Payer: First Choice Health Commercial $23.74
Rate for Payer: First Choice Health Commercial $24.47
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.74
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.47
Rate for Payer: Government Employees Health Association (GEHA) Medicare $14.94
Rate for Payer: Government Employees Health Association (GEHA) Medicare $14.49
Rate for Payer: HealthUtah PPO $24.99
Rate for Payer: HealthUtah PPO $25.76
Rate for Payer: Idaho Integrated Healthcare Commercial $24.24
Rate for Payer: Idaho Integrated Healthcare Commercial $24.99
Rate for Payer: Multiplan Medicare/VA $14.19
Rate for Payer: Multiplan Medicare/VA $13.77
Rate for Payer: One Health Plan of WY PPO $24.49
Rate for Payer: One Health Plan of WY PPO $25.24
Rate for Payer: PacificSource Commercial $23.18
Rate for Payer: PacificSource Commercial $22.49
Rate for Payer: PHCS PPO $24.49
Rate for Payer: PHCS PPO $25.24
Rate for Payer: Three Rivers PPO $18.74
Rate for Payer: Three Rivers PPO $19.32
Rate for Payer: TriWest Veterans Administration $14.94
Rate for Payer: TriWest Veterans Administration $14.49
Rate for Payer: United Healthcare Commercial $21.74
Rate for Payer: United Healthcare Commercial $22.41
Rate for Payer: United Healthcare Medicare $14.94
Rate for Payer: United Healthcare Medicare $14.49
Rate for Payer: WINHealth Partners Commercial $24.49
Rate for Payer: WINHealth Partners Commercial $25.24
Rate for Payer: Wise Provider Network Commercial $23.74
Rate for Payer: Wise Provider Network Commercial $24.47
Service Code HCPCS J2270
Hospital Revenue Code 636
Min. Negotiated Rate $16.15
Max. Negotiated Rate $25.76
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.24
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.49
Rate for Payer: Altius Auto/Workers Compensation $24.73
Rate for Payer: Altius Auto/Workers Compensation $23.99
Rate for Payer: Altius Commercial $23.99
Rate for Payer: Altius Commercial $24.73
Rate for Payer: Beech Street Commercial $25.24
Rate for Payer: Beech Street Commercial $24.49
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.15
Rate for Payer: Cash Price $18.03
Rate for Payer: Cash Price $17.49
Rate for Payer: ChoiceCare Network Commercial $24.24
Rate for Payer: ChoiceCare Network Commercial $24.99
Rate for Payer: Cigna of WY Commercial $25.24
Rate for Payer: Cigna of WY Commercial $24.49
Rate for Payer: Entrust Commercial $23.74
Rate for Payer: Entrust Commercial $24.47
Rate for Payer: First Choice Health Commercial $23.74
Rate for Payer: First Choice Health Commercial $24.47
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.74
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.47
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.49
Rate for Payer: HealthUtah PPO $25.76
Rate for Payer: HealthUtah PPO $24.99
Rate for Payer: Idaho Integrated Healthcare Commercial $24.24
Rate for Payer: Idaho Integrated Healthcare Commercial $24.99
Rate for Payer: Multiplan Medicare/VA $16.15
Rate for Payer: Multiplan Medicare/VA $15.67
Rate for Payer: One Health Plan of WY PPO $25.24
Rate for Payer: One Health Plan of WY PPO $24.49
Rate for Payer: PacificSource Commercial $23.18
Rate for Payer: PacificSource Commercial $22.49
Rate for Payer: PHCS PPO $24.49
Rate for Payer: PHCS PPO $25.24
Rate for Payer: Three Rivers PPO $18.74
Rate for Payer: Three Rivers PPO $19.32
Rate for Payer: TriWest Veterans Administration $17.00
Rate for Payer: TriWest Veterans Administration $16.49
Rate for Payer: United Healthcare Commercial $21.74
Rate for Payer: United Healthcare Commercial $22.41
Rate for Payer: United Healthcare Medicare $17.00
Rate for Payer: United Healthcare Medicare $16.49
Rate for Payer: WINHealth Partners Commercial $23.74
Rate for Payer: WINHealth Partners Commercial $24.47
Rate for Payer: Wise Provider Network Commercial $23.74
Rate for Payer: Wise Provider Network Commercial $24.47
Service Code HCPCS J2270
Hospital Revenue Code 636
Min. Negotiated Rate $18.08
Max. Negotiated Rate $32.82
Rate for Payer: Aetna of WY Commercial/Medical Rental $32.16
Rate for Payer: Aetna of WY Medicare $21.66
Rate for Payer: Altius Auto/Workers Compensation $31.51
Rate for Payer: Altius Commercial $31.51
Rate for Payer: Beech Street Commercial $32.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $26.95
Rate for Payer: Cash Price $22.97
Rate for Payer: ChoiceCare Network Commercial $31.84
Rate for Payer: Cigna of WY Commercial $32.16
Rate for Payer: Entrust Commercial $31.18
Rate for Payer: First Choice Health Commercial $31.18
Rate for Payer: Government Employees Health Association (GEHA) Commercial $31.18
Rate for Payer: Government Employees Health Association (GEHA) Medicare $19.04
Rate for Payer: HealthUtah PPO $32.82
Rate for Payer: Idaho Integrated Healthcare Commercial $31.84
Rate for Payer: Multiplan Medicare/VA $18.08
Rate for Payer: One Health Plan of WY PPO $32.16
Rate for Payer: PacificSource Commercial $29.54
Rate for Payer: PHCS PPO $32.16
Rate for Payer: Three Rivers PPO $24.62
Rate for Payer: TriWest Veterans Administration $19.04
Rate for Payer: United Healthcare Commercial $28.55
Rate for Payer: United Healthcare Medicare $19.04
Rate for Payer: WINHealth Partners Commercial $32.16
Rate for Payer: Wise Provider Network Commercial $31.18
Service Code HCPCS J2270
Hospital Revenue Code 636
Min. Negotiated Rate $20.58
Max. Negotiated Rate $32.82
Rate for Payer: Aetna of WY Commercial/Medical Rental $32.16
Rate for Payer: Altius Auto/Workers Compensation $31.51
Rate for Payer: Altius Commercial $31.51
Rate for Payer: Beech Street Commercial $32.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $26.95
Rate for Payer: Cash Price $22.97
Rate for Payer: ChoiceCare Network Commercial $31.84
Rate for Payer: Cigna of WY Commercial $32.16
Rate for Payer: Entrust Commercial $31.18
Rate for Payer: First Choice Health Commercial $31.18
Rate for Payer: Government Employees Health Association (GEHA) Commercial $31.18
Rate for Payer: Government Employees Health Association (GEHA) Medicare $21.66
Rate for Payer: HealthUtah PPO $32.82
Rate for Payer: Idaho Integrated Healthcare Commercial $31.84
Rate for Payer: Multiplan Medicare/VA $20.58
Rate for Payer: One Health Plan of WY PPO $32.16
Rate for Payer: PacificSource Commercial $29.54
Rate for Payer: PHCS PPO $32.16
Rate for Payer: Three Rivers PPO $24.62
Rate for Payer: TriWest Veterans Administration $21.66
Rate for Payer: United Healthcare Commercial $28.55
Rate for Payer: United Healthcare Medicare $21.66
Rate for Payer: WINHealth Partners Commercial $31.18
Rate for Payer: Wise Provider Network Commercial $31.18
Service Code NDC 0406800315
Hospital Revenue Code 250
Min. Negotiated Rate $1.32
Max. Negotiated Rate $2.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.35
Rate for Payer: Aetna of WY Medicare $1.58
Rate for Payer: Altius Auto/Workers Compensation $2.30
Rate for Payer: Altius Commercial $2.30
Rate for Payer: Beech Street Commercial $2.35
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.97
Rate for Payer: Cash Price $1.68
Rate for Payer: ChoiceCare Network Commercial $2.33
Rate for Payer: Cigna of WY Commercial $2.35
Rate for Payer: Entrust Commercial $2.28
Rate for Payer: First Choice Health Commercial $2.28
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.28
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.39
Rate for Payer: HealthUtah PPO $2.40
Rate for Payer: Idaho Integrated Healthcare Commercial $2.33
Rate for Payer: Multiplan Medicare/VA $1.32
Rate for Payer: One Health Plan of WY PPO $2.35
Rate for Payer: PacificSource Commercial $2.16
Rate for Payer: PHCS PPO $2.35
Rate for Payer: Three Rivers PPO $1.80
Rate for Payer: TriWest Veterans Administration $1.39
Rate for Payer: United Healthcare Commercial $2.09
Rate for Payer: United Healthcare Medicare $1.39
Rate for Payer: WINHealth Partners Commercial $2.35
Rate for Payer: Wise Provider Network Commercial $2.28
Service Code NDC 0406800315
Hospital Revenue Code 250
Min. Negotiated Rate $1.50
Max. Negotiated Rate $2.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.35
Rate for Payer: Altius Auto/Workers Compensation $2.30
Rate for Payer: Altius Commercial $2.30
Rate for Payer: Beech Street Commercial $2.35
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.97
Rate for Payer: Cash Price $1.68
Rate for Payer: ChoiceCare Network Commercial $2.33
Rate for Payer: Cigna of WY Commercial $2.35
Rate for Payer: Entrust Commercial $2.28
Rate for Payer: First Choice Health Commercial $2.28
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.28
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.58
Rate for Payer: HealthUtah PPO $2.40
Rate for Payer: Idaho Integrated Healthcare Commercial $2.33
Rate for Payer: Multiplan Medicare/VA $1.50
Rate for Payer: One Health Plan of WY PPO $2.35
Rate for Payer: PacificSource Commercial $2.16
Rate for Payer: PHCS PPO $2.35
Rate for Payer: Three Rivers PPO $1.80
Rate for Payer: TriWest Veterans Administration $1.58
Rate for Payer: United Healthcare Commercial $2.09
Rate for Payer: United Healthcare Medicare $1.58
Rate for Payer: WINHealth Partners Commercial $2.28
Rate for Payer: Wise Provider Network Commercial $2.28
Service Code NDC 4285880101
Hospital Revenue Code 250
Min. Negotiated Rate $1.03
Max. Negotiated Rate $1.87
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.83
Rate for Payer: Aetna of WY Medicare $1.23
Rate for Payer: Altius Auto/Workers Compensation $1.80
Rate for Payer: Altius Commercial $1.80
Rate for Payer: Beech Street Commercial $1.83
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.54
Rate for Payer: Cash Price $1.31
Rate for Payer: ChoiceCare Network Commercial $1.81
Rate for Payer: Cigna of WY Commercial $1.83
Rate for Payer: Entrust Commercial $1.78
Rate for Payer: First Choice Health Commercial $1.78
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.78
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.08
Rate for Payer: HealthUtah PPO $1.87
Rate for Payer: Idaho Integrated Healthcare Commercial $1.81
Rate for Payer: Multiplan Medicare/VA $1.03
Rate for Payer: One Health Plan of WY PPO $1.83
Rate for Payer: PacificSource Commercial $1.68
Rate for Payer: PHCS PPO $1.83
Rate for Payer: Three Rivers PPO $1.40
Rate for Payer: TriWest Veterans Administration $1.08
Rate for Payer: United Healthcare Commercial $1.63
Rate for Payer: United Healthcare Medicare $1.08
Rate for Payer: WINHealth Partners Commercial $1.83
Rate for Payer: Wise Provider Network Commercial $1.78
Service Code NDC 6808415711
Hospital Revenue Code 250
Min. Negotiated Rate $1.78
Max. Negotiated Rate $3.23
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.17
Rate for Payer: Aetna of WY Medicare $2.13
Rate for Payer: Altius Auto/Workers Compensation $3.10
Rate for Payer: Altius Commercial $3.10
Rate for Payer: Beech Street Commercial $3.17
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.65
Rate for Payer: Cash Price $2.26
Rate for Payer: ChoiceCare Network Commercial $3.13
Rate for Payer: Cigna of WY Commercial $3.17
Rate for Payer: Entrust Commercial $3.07
Rate for Payer: First Choice Health Commercial $3.07
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.07
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.87
Rate for Payer: HealthUtah PPO $3.23
Rate for Payer: Idaho Integrated Healthcare Commercial $3.13
Rate for Payer: Multiplan Medicare/VA $1.78
Rate for Payer: One Health Plan of WY PPO $3.17
Rate for Payer: PacificSource Commercial $2.91
Rate for Payer: PHCS PPO $3.17
Rate for Payer: Three Rivers PPO $2.42
Rate for Payer: TriWest Veterans Administration $1.87
Rate for Payer: United Healthcare Commercial $2.81
Rate for Payer: United Healthcare Medicare $1.87
Rate for Payer: WINHealth Partners Commercial $3.17
Rate for Payer: Wise Provider Network Commercial $3.07
Service Code NDC 6808415711
Hospital Revenue Code 250
Min. Negotiated Rate $2.03
Max. Negotiated Rate $3.23
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.17
Rate for Payer: Altius Auto/Workers Compensation $3.10
Rate for Payer: Altius Commercial $3.10
Rate for Payer: Beech Street Commercial $3.17
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.65
Rate for Payer: Cash Price $2.26
Rate for Payer: ChoiceCare Network Commercial $3.13
Rate for Payer: Cigna of WY Commercial $3.17
Rate for Payer: Entrust Commercial $3.07
Rate for Payer: First Choice Health Commercial $3.07
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.07
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2.13
Rate for Payer: HealthUtah PPO $3.23
Rate for Payer: Idaho Integrated Healthcare Commercial $3.13
Rate for Payer: Multiplan Medicare/VA $2.03
Rate for Payer: One Health Plan of WY PPO $3.17
Rate for Payer: PacificSource Commercial $2.91
Rate for Payer: PHCS PPO $3.17
Rate for Payer: Three Rivers PPO $2.42
Rate for Payer: TriWest Veterans Administration $2.13
Rate for Payer: United Healthcare Commercial $2.81
Rate for Payer: United Healthcare Medicare $2.13
Rate for Payer: WINHealth Partners Commercial $3.07
Rate for Payer: Wise Provider Network Commercial $3.07
Service Code NDC 0406831501
Hospital Revenue Code 250
Min. Negotiated Rate $1.68
Max. Negotiated Rate $2.68
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.63
Rate for Payer: Altius Auto/Workers Compensation $2.57
Rate for Payer: Altius Commercial $2.57
Rate for Payer: Beech Street Commercial $2.63
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.20
Rate for Payer: Cash Price $1.88
Rate for Payer: ChoiceCare Network Commercial $2.60
Rate for Payer: Cigna of WY Commercial $2.63
Rate for Payer: Entrust Commercial $2.55
Rate for Payer: First Choice Health Commercial $2.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.77
Rate for Payer: HealthUtah PPO $2.68
Rate for Payer: Idaho Integrated Healthcare Commercial $2.60
Rate for Payer: Multiplan Medicare/VA $1.68
Rate for Payer: One Health Plan of WY PPO $2.63
Rate for Payer: PacificSource Commercial $2.41
Rate for Payer: PHCS PPO $2.63
Rate for Payer: Three Rivers PPO $2.01
Rate for Payer: TriWest Veterans Administration $1.77
Rate for Payer: United Healthcare Commercial $2.33
Rate for Payer: United Healthcare Medicare $1.77
Rate for Payer: WINHealth Partners Commercial $2.55
Rate for Payer: Wise Provider Network Commercial $2.55
Service Code NDC 0406831501
Hospital Revenue Code 250
Min. Negotiated Rate $1.48
Max. Negotiated Rate $2.68
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.63
Rate for Payer: Aetna of WY Medicare $1.77
Rate for Payer: Altius Auto/Workers Compensation $2.57
Rate for Payer: Altius Commercial $2.57
Rate for Payer: Beech Street Commercial $2.63
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.20
Rate for Payer: Cash Price $1.88
Rate for Payer: ChoiceCare Network Commercial $2.60
Rate for Payer: Cigna of WY Commercial $2.63
Rate for Payer: Entrust Commercial $2.55
Rate for Payer: First Choice Health Commercial $2.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.55
Rate for Payer: HealthUtah PPO $2.68
Rate for Payer: Idaho Integrated Healthcare Commercial $2.60
Rate for Payer: Multiplan Medicare/VA $1.48
Rate for Payer: One Health Plan of WY PPO $2.63
Rate for Payer: PacificSource Commercial $2.41
Rate for Payer: PHCS PPO $2.63
Rate for Payer: Three Rivers PPO $2.01
Rate for Payer: TriWest Veterans Administration $1.55
Rate for Payer: United Healthcare Commercial $2.33
Rate for Payer: United Healthcare Medicare $1.55
Rate for Payer: WINHealth Partners Commercial $2.63
Rate for Payer: Wise Provider Network Commercial $2.55
Service Code NDC 4285880101
Hospital Revenue Code 250
Min. Negotiated Rate $1.17
Max. Negotiated Rate $1.87
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.83
Rate for Payer: Altius Auto/Workers Compensation $1.80
Rate for Payer: Altius Commercial $1.80
Rate for Payer: Beech Street Commercial $1.83
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.54
Rate for Payer: Cash Price $1.31
Rate for Payer: ChoiceCare Network Commercial $1.81
Rate for Payer: Cigna of WY Commercial $1.83
Rate for Payer: Entrust Commercial $1.78
Rate for Payer: First Choice Health Commercial $1.78
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.78
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.23
Rate for Payer: HealthUtah PPO $1.87
Rate for Payer: Idaho Integrated Healthcare Commercial $1.81
Rate for Payer: Multiplan Medicare/VA $1.17
Rate for Payer: One Health Plan of WY PPO $1.83
Rate for Payer: PacificSource Commercial $1.68
Rate for Payer: PHCS PPO $1.83
Rate for Payer: Three Rivers PPO $1.40
Rate for Payer: TriWest Veterans Administration $1.23
Rate for Payer: United Healthcare Commercial $1.63
Rate for Payer: United Healthcare Medicare $1.23
Rate for Payer: WINHealth Partners Commercial $1.78
Rate for Payer: Wise Provider Network Commercial $1.78
Service Code HCPCS J2274
Hospital Revenue Code 636
Min. Negotiated Rate $16.21
Max. Negotiated Rate $25.86
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.34
Rate for Payer: Altius Auto/Workers Compensation $24.83
Rate for Payer: Altius Commercial $24.83
Rate for Payer: Beech Street Commercial $25.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.23
Rate for Payer: Cash Price $18.10
Rate for Payer: ChoiceCare Network Commercial $25.08
Rate for Payer: Cigna of WY Commercial $25.34
Rate for Payer: Entrust Commercial $24.57
Rate for Payer: First Choice Health Commercial $24.57
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.57
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.07
Rate for Payer: HealthUtah PPO $25.86
Rate for Payer: Idaho Integrated Healthcare Commercial $25.08
Rate for Payer: Multiplan Medicare/VA $16.21
Rate for Payer: One Health Plan of WY PPO $25.34
Rate for Payer: PacificSource Commercial $23.27
Rate for Payer: PHCS PPO $25.34
Rate for Payer: Three Rivers PPO $19.40
Rate for Payer: TriWest Veterans Administration $17.07
Rate for Payer: United Healthcare Commercial $22.50
Rate for Payer: United Healthcare Medicare $17.07
Rate for Payer: WINHealth Partners Commercial $24.57
Rate for Payer: Wise Provider Network Commercial $24.57
Service Code HCPCS J2274
Hospital Revenue Code 636
Min. Negotiated Rate $14.25
Max. Negotiated Rate $25.86
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.34
Rate for Payer: Aetna of WY Medicare $17.07
Rate for Payer: Altius Auto/Workers Compensation $24.83
Rate for Payer: Altius Commercial $24.83
Rate for Payer: Beech Street Commercial $25.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.23
Rate for Payer: Cash Price $18.10
Rate for Payer: ChoiceCare Network Commercial $25.08
Rate for Payer: Cigna of WY Commercial $25.34
Rate for Payer: Entrust Commercial $24.57
Rate for Payer: First Choice Health Commercial $24.57
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.57
Rate for Payer: Government Employees Health Association (GEHA) Medicare $15.00
Rate for Payer: HealthUtah PPO $25.86
Rate for Payer: Idaho Integrated Healthcare Commercial $25.08
Rate for Payer: Multiplan Medicare/VA $14.25
Rate for Payer: One Health Plan of WY PPO $25.34
Rate for Payer: PacificSource Commercial $23.27
Rate for Payer: PHCS PPO $25.34
Rate for Payer: Three Rivers PPO $19.40
Rate for Payer: TriWest Veterans Administration $15.00
Rate for Payer: United Healthcare Commercial $22.50
Rate for Payer: United Healthcare Medicare $15.00
Rate for Payer: WINHealth Partners Commercial $25.34
Rate for Payer: Wise Provider Network Commercial $24.57
Service Code HCPCS J2270
Hospital Charge Code J2270
Min. Negotiated Rate $3.79
Max. Negotiated Rate $36.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $35.28
Rate for Payer: Aetna of WY Medicare $4.46
Rate for Payer: Beech Street Commercial $34.20
Rate for Payer: Cash Price $25.20
Rate for Payer: Cash Price $25.20
Rate for Payer: ChoiceCare Network Commercial $34.92
Rate for Payer: Cigna of WY Commercial $35.28
Rate for Payer: First Choice Health Commercial $32.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $34.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4.46
Rate for Payer: HealthUtah PPO $36.00
Rate for Payer: Idaho Integrated Healthcare Commercial $34.92
Rate for Payer: Multiplan Medicare/VA $3.79
Rate for Payer: One Health Plan of WY PPO $35.28
Rate for Payer: PacificSource Commercial $32.40
Rate for Payer: PHCS PPO $34.20
Rate for Payer: Three Rivers PPO $27.00
Rate for Payer: TriWest Veterans Administration $4.46
Rate for Payer: United Healthcare Commercial $31.32
Rate for Payer: United Healthcare Medicare $4.46
Rate for Payer: WINHealth Partners Commercial $34.20
Service Code HCPCS 92611
Hospital Charge Code 92611
Min. Negotiated Rate $76.31
Max. Negotiated Rate $315.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $308.70
Rate for Payer: Aetna of WY Medicare $89.78
Rate for Payer: Beech Street Commercial $299.25
Rate for Payer: Cash Price $220.50
Rate for Payer: Cash Price $220.50
Rate for Payer: ChoiceCare Network Commercial $305.55
Rate for Payer: Cigna of WY Commercial $308.70
Rate for Payer: First Choice Health Commercial $283.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $299.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $89.78
Rate for Payer: HealthUtah PPO $315.00
Rate for Payer: Idaho Integrated Healthcare Commercial $305.55
Rate for Payer: Multiplan Medicare/VA $76.31
Rate for Payer: One Health Plan of WY PPO $308.70
Rate for Payer: PacificSource Commercial $283.50
Rate for Payer: PHCS PPO $299.25
Rate for Payer: Three Rivers PPO $236.25
Rate for Payer: TriWest Veterans Administration $89.78
Rate for Payer: United Healthcare Commercial $274.05
Rate for Payer: United Healthcare Medicare $89.78
Rate for Payer: WINHealth Partners Commercial $299.25
Service Code NDC 1366820130
Hospital Revenue Code 250
Min. Negotiated Rate $16.12
Max. Negotiated Rate $29.25
Rate for Payer: Aetna of WY Commercial/Medical Rental $28.66
Rate for Payer: Aetna of WY Medicare $19.30
Rate for Payer: Altius Auto/Workers Compensation $28.08
Rate for Payer: Altius Commercial $28.08
Rate for Payer: Beech Street Commercial $28.66
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $24.01
Rate for Payer: Cash Price $20.47
Rate for Payer: ChoiceCare Network Commercial $28.37
Rate for Payer: Cigna of WY Commercial $28.66
Rate for Payer: Entrust Commercial $27.79
Rate for Payer: First Choice Health Commercial $27.79
Rate for Payer: Government Employees Health Association (GEHA) Commercial $27.79
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.96
Rate for Payer: HealthUtah PPO $29.25
Rate for Payer: Idaho Integrated Healthcare Commercial $28.37
Rate for Payer: Multiplan Medicare/VA $16.12
Rate for Payer: One Health Plan of WY PPO $28.66
Rate for Payer: PacificSource Commercial $26.32
Rate for Payer: PHCS PPO $28.66
Rate for Payer: Three Rivers PPO $21.94
Rate for Payer: TriWest Veterans Administration $16.96
Rate for Payer: United Healthcare Commercial $25.45
Rate for Payer: United Healthcare Medicare $16.96
Rate for Payer: WINHealth Partners Commercial $28.66
Rate for Payer: Wise Provider Network Commercial $27.79
Service Code NDC 1366820130
Hospital Revenue Code 250
Min. Negotiated Rate $18.34
Max. Negotiated Rate $29.25
Rate for Payer: Aetna of WY Commercial/Medical Rental $28.66
Rate for Payer: Altius Auto/Workers Compensation $28.08
Rate for Payer: Altius Commercial $28.08
Rate for Payer: Beech Street Commercial $28.66
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $24.01
Rate for Payer: Cash Price $20.47
Rate for Payer: ChoiceCare Network Commercial $28.37
Rate for Payer: Cigna of WY Commercial $28.66
Rate for Payer: Entrust Commercial $27.79
Rate for Payer: First Choice Health Commercial $27.79
Rate for Payer: Government Employees Health Association (GEHA) Commercial $27.79
Rate for Payer: Government Employees Health Association (GEHA) Medicare $19.30
Rate for Payer: HealthUtah PPO $29.25
Rate for Payer: Idaho Integrated Healthcare Commercial $28.37
Rate for Payer: Multiplan Medicare/VA $18.34
Rate for Payer: One Health Plan of WY PPO $28.66
Rate for Payer: PacificSource Commercial $26.32
Rate for Payer: PHCS PPO $28.66
Rate for Payer: Three Rivers PPO $21.94
Rate for Payer: TriWest Veterans Administration $19.30
Rate for Payer: United Healthcare Commercial $25.45
Rate for Payer: United Healthcare Medicare $19.30
Rate for Payer: WINHealth Partners Commercial $27.79
Rate for Payer: Wise Provider Network Commercial $27.79
Service Code NDC 6808472211
Hospital Revenue Code 250
Min. Negotiated Rate $19.01
Max. Negotiated Rate $34.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $33.81
Rate for Payer: Aetna of WY Medicare $22.77
Rate for Payer: Altius Auto/Workers Compensation $33.12
Rate for Payer: Altius Commercial $33.12
Rate for Payer: Beech Street Commercial $33.81
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $28.32
Rate for Payer: Cash Price $24.15
Rate for Payer: ChoiceCare Network Commercial $33.46
Rate for Payer: Cigna of WY Commercial $33.81
Rate for Payer: Entrust Commercial $32.78
Rate for Payer: First Choice Health Commercial $32.78
Rate for Payer: Government Employees Health Association (GEHA) Commercial $32.78
Rate for Payer: Government Employees Health Association (GEHA) Medicare $20.01
Rate for Payer: HealthUtah PPO $34.50
Rate for Payer: Idaho Integrated Healthcare Commercial $33.46
Rate for Payer: Multiplan Medicare/VA $19.01
Rate for Payer: One Health Plan of WY PPO $33.81
Rate for Payer: PacificSource Commercial $31.05
Rate for Payer: PHCS PPO $33.81
Rate for Payer: Three Rivers PPO $25.88
Rate for Payer: TriWest Veterans Administration $20.01
Rate for Payer: United Healthcare Commercial $30.02
Rate for Payer: United Healthcare Medicare $20.01
Rate for Payer: WINHealth Partners Commercial $33.81
Rate for Payer: Wise Provider Network Commercial $32.78
Service Code NDC 6808472211
Hospital Revenue Code 250
Min. Negotiated Rate $21.63
Max. Negotiated Rate $34.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $33.81
Rate for Payer: Altius Auto/Workers Compensation $33.12
Rate for Payer: Altius Commercial $33.12
Rate for Payer: Beech Street Commercial $33.81
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $28.32
Rate for Payer: Cash Price $24.15
Rate for Payer: ChoiceCare Network Commercial $33.46
Rate for Payer: Cigna of WY Commercial $33.81
Rate for Payer: Entrust Commercial $32.78
Rate for Payer: First Choice Health Commercial $32.78
Rate for Payer: Government Employees Health Association (GEHA) Commercial $32.78
Rate for Payer: Government Employees Health Association (GEHA) Medicare $22.77
Rate for Payer: HealthUtah PPO $34.50
Rate for Payer: Idaho Integrated Healthcare Commercial $33.46
Rate for Payer: Multiplan Medicare/VA $21.63
Rate for Payer: One Health Plan of WY PPO $33.81
Rate for Payer: PacificSource Commercial $31.05
Rate for Payer: PHCS PPO $33.81
Rate for Payer: Three Rivers PPO $25.88
Rate for Payer: TriWest Veterans Administration $22.77
Rate for Payer: United Healthcare Commercial $30.02
Rate for Payer: United Healthcare Medicare $22.77
Rate for Payer: WINHealth Partners Commercial $32.78
Rate for Payer: Wise Provider Network Commercial $32.78
Service Code HCPCS 90733
Hospital Charge Code 90733
Min. Negotiated Rate $139.50
Max. Negotiated Rate $186.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $182.28
Rate for Payer: Beech Street Commercial $176.70
Rate for Payer: Cash Price $130.20
Rate for Payer: ChoiceCare Network Commercial $180.42
Rate for Payer: Cigna of WY Commercial $182.28
Rate for Payer: First Choice Health Commercial $167.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $176.70
Rate for Payer: HealthUtah PPO $186.00
Rate for Payer: Idaho Integrated Healthcare Commercial $180.42
Rate for Payer: One Health Plan of WY PPO $182.28
Rate for Payer: PacificSource Commercial $167.40
Rate for Payer: PHCS PPO $176.70
Rate for Payer: Three Rivers PPO $139.50
Rate for Payer: United Healthcare Commercial $161.82
Rate for Payer: WINHealth Partners Commercial $186.00
Service Code NDC 4098522368
Hospital Revenue Code 250
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.17
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.17
Rate for Payer: Aetna of WY Medicare $0.11
Rate for Payer: Altius Auto/Workers Compensation $0.16
Rate for Payer: Altius Commercial $0.16
Rate for Payer: Beech Street Commercial $0.17
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.14
Rate for Payer: Cash Price $0.12
Rate for Payer: ChoiceCare Network Commercial $0.16
Rate for Payer: Cigna of WY Commercial $0.17
Rate for Payer: Entrust Commercial $0.16
Rate for Payer: First Choice Health Commercial $0.16
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.16
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.10
Rate for Payer: HealthUtah PPO $0.17
Rate for Payer: Idaho Integrated Healthcare Commercial $0.16
Rate for Payer: Multiplan Medicare/VA $0.09
Rate for Payer: One Health Plan of WY PPO $0.17
Rate for Payer: PacificSource Commercial $0.15
Rate for Payer: PHCS PPO $0.17
Rate for Payer: Three Rivers PPO $0.13
Rate for Payer: TriWest Veterans Administration $0.10
Rate for Payer: United Healthcare Commercial $0.15
Rate for Payer: United Healthcare Medicare $0.10
Rate for Payer: WINHealth Partners Commercial $0.17
Rate for Payer: Wise Provider Network Commercial $0.16