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Service Code NDC 4110081127
Hospital Revenue Code 250
Min. Negotiated Rate $0.94
Max. Negotiated Rate $1.70
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.67
Rate for Payer: Aetna of WY Medicare $1.12
Rate for Payer: Altius Auto/Workers Compensation $1.63
Rate for Payer: Altius Commercial $1.63
Rate for Payer: Beech Street Commercial $1.67
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.40
Rate for Payer: Cash Price $1.19
Rate for Payer: ChoiceCare Network Commercial $1.65
Rate for Payer: Cigna of WY Commercial $1.67
Rate for Payer: Entrust Commercial $1.62
Rate for Payer: First Choice Health Commercial $1.62
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.62
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.99
Rate for Payer: HealthUtah PPO $1.70
Rate for Payer: Idaho Integrated Healthcare Commercial $1.65
Rate for Payer: Multiplan Medicare/VA $0.94
Rate for Payer: One Health Plan of WY PPO $1.67
Rate for Payer: PacificSource Commercial $1.53
Rate for Payer: PHCS PPO $1.67
Rate for Payer: Three Rivers PPO $1.28
Rate for Payer: TriWest Veterans Administration $0.99
Rate for Payer: United Healthcare Commercial $1.48
Rate for Payer: United Healthcare Medicare $0.99
Rate for Payer: WINHealth Partners Commercial $1.67
Rate for Payer: Wise Provider Network Commercial $1.62
Service Code NDC 0904743535
Hospital Revenue Code 250
Min. Negotiated Rate $0.29
Max. Negotiated Rate $0.53
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.52
Rate for Payer: Aetna of WY Medicare $0.35
Rate for Payer: Altius Auto/Workers Compensation $0.51
Rate for Payer: Altius Commercial $0.51
Rate for Payer: Beech Street Commercial $0.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.44
Rate for Payer: Cash Price $0.37
Rate for Payer: ChoiceCare Network Commercial $0.51
Rate for Payer: Cigna of WY Commercial $0.52
Rate for Payer: Entrust Commercial $0.50
Rate for Payer: First Choice Health Commercial $0.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.31
Rate for Payer: HealthUtah PPO $0.53
Rate for Payer: Idaho Integrated Healthcare Commercial $0.51
Rate for Payer: Multiplan Medicare/VA $0.29
Rate for Payer: One Health Plan of WY PPO $0.52
Rate for Payer: PacificSource Commercial $0.48
Rate for Payer: PHCS PPO $0.52
Rate for Payer: Three Rivers PPO $0.40
Rate for Payer: TriWest Veterans Administration $0.31
Rate for Payer: United Healthcare Commercial $0.46
Rate for Payer: United Healthcare Medicare $0.31
Rate for Payer: WINHealth Partners Commercial $0.52
Rate for Payer: Wise Provider Network Commercial $0.50
Service Code NDC 0904743535
Hospital Revenue Code 250
Min. Negotiated Rate $0.33
Max. Negotiated Rate $0.53
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.52
Rate for Payer: Altius Auto/Workers Compensation $0.51
Rate for Payer: Altius Commercial $0.51
Rate for Payer: Beech Street Commercial $0.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.44
Rate for Payer: Cash Price $0.37
Rate for Payer: ChoiceCare Network Commercial $0.51
Rate for Payer: Cigna of WY Commercial $0.52
Rate for Payer: Entrust Commercial $0.50
Rate for Payer: First Choice Health Commercial $0.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.35
Rate for Payer: HealthUtah PPO $0.53
Rate for Payer: Idaho Integrated Healthcare Commercial $0.51
Rate for Payer: Multiplan Medicare/VA $0.33
Rate for Payer: One Health Plan of WY PPO $0.52
Rate for Payer: PacificSource Commercial $0.48
Rate for Payer: PHCS PPO $0.52
Rate for Payer: Three Rivers PPO $0.40
Rate for Payer: TriWest Veterans Administration $0.35
Rate for Payer: United Healthcare Commercial $0.46
Rate for Payer: United Healthcare Medicare $0.35
Rate for Payer: WINHealth Partners Commercial $0.50
Rate for Payer: Wise Provider Network Commercial $0.50
Service Code NDC 0904700635
Hospital Revenue Code 250
Min. Negotiated Rate $0.29
Max. Negotiated Rate $0.53
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.52
Rate for Payer: Aetna of WY Medicare $0.35
Rate for Payer: Altius Auto/Workers Compensation $0.51
Rate for Payer: Altius Commercial $0.51
Rate for Payer: Beech Street Commercial $0.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.44
Rate for Payer: Cash Price $0.37
Rate for Payer: ChoiceCare Network Commercial $0.51
Rate for Payer: Cigna of WY Commercial $0.52
Rate for Payer: Entrust Commercial $0.50
Rate for Payer: First Choice Health Commercial $0.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.31
Rate for Payer: HealthUtah PPO $0.53
Rate for Payer: Idaho Integrated Healthcare Commercial $0.51
Rate for Payer: Multiplan Medicare/VA $0.29
Rate for Payer: One Health Plan of WY PPO $0.52
Rate for Payer: PacificSource Commercial $0.48
Rate for Payer: PHCS PPO $0.52
Rate for Payer: Three Rivers PPO $0.40
Rate for Payer: TriWest Veterans Administration $0.31
Rate for Payer: United Healthcare Commercial $0.46
Rate for Payer: United Healthcare Medicare $0.31
Rate for Payer: WINHealth Partners Commercial $0.52
Rate for Payer: Wise Provider Network Commercial $0.50
Service Code NDC 6332301211
Hospital Revenue Code 250
Min. Negotiated Rate $15.39
Max. Negotiated Rate $27.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.38
Rate for Payer: Aetna of WY Medicare $18.44
Rate for Payer: Altius Auto/Workers Compensation $26.82
Rate for Payer: Altius Commercial $26.82
Rate for Payer: Beech Street Commercial $27.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $22.94
Rate for Payer: Cash Price $19.56
Rate for Payer: ChoiceCare Network Commercial $27.10
Rate for Payer: Cigna of WY Commercial $27.38
Rate for Payer: Entrust Commercial $26.54
Rate for Payer: First Choice Health Commercial $26.54
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.54
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.21
Rate for Payer: HealthUtah PPO $27.94
Rate for Payer: Idaho Integrated Healthcare Commercial $27.10
Rate for Payer: Multiplan Medicare/VA $15.39
Rate for Payer: One Health Plan of WY PPO $27.38
Rate for Payer: PacificSource Commercial $25.15
Rate for Payer: PHCS PPO $27.38
Rate for Payer: Three Rivers PPO $20.96
Rate for Payer: TriWest Veterans Administration $16.21
Rate for Payer: United Healthcare Commercial $24.31
Rate for Payer: United Healthcare Medicare $16.21
Rate for Payer: WINHealth Partners Commercial $27.38
Rate for Payer: Wise Provider Network Commercial $26.54
Service Code NDC 6332301211
Hospital Revenue Code 250
Min. Negotiated Rate $17.52
Max. Negotiated Rate $27.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.38
Rate for Payer: Altius Auto/Workers Compensation $26.82
Rate for Payer: Altius Commercial $26.82
Rate for Payer: Beech Street Commercial $27.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $22.94
Rate for Payer: Cash Price $19.56
Rate for Payer: ChoiceCare Network Commercial $27.10
Rate for Payer: Cigna of WY Commercial $27.38
Rate for Payer: Entrust Commercial $26.54
Rate for Payer: First Choice Health Commercial $26.54
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.54
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.44
Rate for Payer: HealthUtah PPO $27.94
Rate for Payer: Idaho Integrated Healthcare Commercial $27.10
Rate for Payer: Multiplan Medicare/VA $17.52
Rate for Payer: One Health Plan of WY PPO $27.38
Rate for Payer: PacificSource Commercial $25.15
Rate for Payer: PHCS PPO $27.38
Rate for Payer: Three Rivers PPO $20.96
Rate for Payer: TriWest Veterans Administration $18.44
Rate for Payer: United Healthcare Commercial $24.31
Rate for Payer: United Healthcare Medicare $18.44
Rate for Payer: WINHealth Partners Commercial $26.54
Rate for Payer: Wise Provider Network Commercial $26.54
Service Code NDC 4202311625
Hospital Revenue Code 250
Min. Negotiated Rate $17.87
Max. Negotiated Rate $28.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.93
Rate for Payer: Altius Auto/Workers Compensation $27.36
Rate for Payer: Altius Commercial $27.36
Rate for Payer: Beech Street Commercial $27.93
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $23.40
Rate for Payer: Cash Price $19.95
Rate for Payer: ChoiceCare Network Commercial $27.64
Rate for Payer: Cigna of WY Commercial $27.93
Rate for Payer: Entrust Commercial $27.08
Rate for Payer: First Choice Health Commercial $27.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $27.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.81
Rate for Payer: HealthUtah PPO $28.50
Rate for Payer: Idaho Integrated Healthcare Commercial $27.64
Rate for Payer: Multiplan Medicare/VA $17.87
Rate for Payer: One Health Plan of WY PPO $27.93
Rate for Payer: PacificSource Commercial $25.65
Rate for Payer: PHCS PPO $27.93
Rate for Payer: Three Rivers PPO $21.38
Rate for Payer: TriWest Veterans Administration $18.81
Rate for Payer: United Healthcare Commercial $24.80
Rate for Payer: United Healthcare Medicare $18.81
Rate for Payer: WINHealth Partners Commercial $27.08
Rate for Payer: Wise Provider Network Commercial $27.08
Service Code NDC 6332301203
Hospital Revenue Code 250
Min. Negotiated Rate $17.52
Max. Negotiated Rate $27.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.38
Rate for Payer: Altius Auto/Workers Compensation $26.82
Rate for Payer: Altius Commercial $26.82
Rate for Payer: Beech Street Commercial $27.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $22.94
Rate for Payer: Cash Price $19.56
Rate for Payer: ChoiceCare Network Commercial $27.10
Rate for Payer: Cigna of WY Commercial $27.38
Rate for Payer: Entrust Commercial $26.54
Rate for Payer: First Choice Health Commercial $26.54
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.54
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.44
Rate for Payer: HealthUtah PPO $27.94
Rate for Payer: Idaho Integrated Healthcare Commercial $27.10
Rate for Payer: Multiplan Medicare/VA $17.52
Rate for Payer: One Health Plan of WY PPO $27.38
Rate for Payer: PacificSource Commercial $25.15
Rate for Payer: PHCS PPO $27.38
Rate for Payer: Three Rivers PPO $20.96
Rate for Payer: TriWest Veterans Administration $18.44
Rate for Payer: United Healthcare Commercial $24.31
Rate for Payer: United Healthcare Medicare $18.44
Rate for Payer: WINHealth Partners Commercial $26.54
Rate for Payer: Wise Provider Network Commercial $26.54
Service Code NDC 4202311625
Hospital Revenue Code 250
Min. Negotiated Rate $15.70
Max. Negotiated Rate $28.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.93
Rate for Payer: Aetna of WY Medicare $18.81
Rate for Payer: Altius Auto/Workers Compensation $27.36
Rate for Payer: Altius Commercial $27.36
Rate for Payer: Beech Street Commercial $27.93
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $23.40
Rate for Payer: Cash Price $19.95
Rate for Payer: ChoiceCare Network Commercial $27.64
Rate for Payer: Cigna of WY Commercial $27.93
Rate for Payer: Entrust Commercial $27.08
Rate for Payer: First Choice Health Commercial $27.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $27.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.53
Rate for Payer: HealthUtah PPO $28.50
Rate for Payer: Idaho Integrated Healthcare Commercial $27.64
Rate for Payer: Multiplan Medicare/VA $15.70
Rate for Payer: One Health Plan of WY PPO $27.93
Rate for Payer: PacificSource Commercial $25.65
Rate for Payer: PHCS PPO $27.93
Rate for Payer: Three Rivers PPO $21.38
Rate for Payer: TriWest Veterans Administration $16.53
Rate for Payer: United Healthcare Commercial $24.80
Rate for Payer: United Healthcare Medicare $16.53
Rate for Payer: WINHealth Partners Commercial $27.93
Rate for Payer: Wise Provider Network Commercial $27.08
Service Code NDC 6332301203
Hospital Revenue Code 250
Min. Negotiated Rate $15.39
Max. Negotiated Rate $27.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.38
Rate for Payer: Aetna of WY Medicare $18.44
Rate for Payer: Altius Auto/Workers Compensation $26.82
Rate for Payer: Altius Commercial $26.82
Rate for Payer: Beech Street Commercial $27.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $22.94
Rate for Payer: Cash Price $19.56
Rate for Payer: ChoiceCare Network Commercial $27.10
Rate for Payer: Cigna of WY Commercial $27.38
Rate for Payer: Entrust Commercial $26.54
Rate for Payer: First Choice Health Commercial $26.54
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.54
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.21
Rate for Payer: HealthUtah PPO $27.94
Rate for Payer: Idaho Integrated Healthcare Commercial $27.10
Rate for Payer: Multiplan Medicare/VA $15.39
Rate for Payer: One Health Plan of WY PPO $27.38
Rate for Payer: PacificSource Commercial $25.15
Rate for Payer: PHCS PPO $27.38
Rate for Payer: Three Rivers PPO $20.96
Rate for Payer: TriWest Veterans Administration $16.21
Rate for Payer: United Healthcare Commercial $24.31
Rate for Payer: United Healthcare Medicare $16.21
Rate for Payer: WINHealth Partners Commercial $27.38
Rate for Payer: Wise Provider Network Commercial $26.54
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $100.22
Max. Negotiated Rate $159.84
Rate for Payer: Aetna of WY Commercial/Medical Rental $156.64
Rate for Payer: Altius Auto/Workers Compensation $153.45
Rate for Payer: Altius Commercial $153.45
Rate for Payer: Beech Street Commercial $156.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $131.23
Rate for Payer: Cash Price $111.89
Rate for Payer: ChoiceCare Network Commercial $155.04
Rate for Payer: Cigna of WY Commercial $156.64
Rate for Payer: Entrust Commercial $151.85
Rate for Payer: First Choice Health Commercial $151.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $151.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $105.49
Rate for Payer: HealthUtah PPO $159.84
Rate for Payer: Idaho Integrated Healthcare Commercial $155.04
Rate for Payer: Multiplan Medicare/VA $100.22
Rate for Payer: One Health Plan of WY PPO $156.64
Rate for Payer: PacificSource Commercial $143.86
Rate for Payer: PHCS PPO $156.64
Rate for Payer: Three Rivers PPO $119.88
Rate for Payer: TriWest Veterans Administration $105.49
Rate for Payer: United Healthcare Commercial $139.06
Rate for Payer: United Healthcare Medicare $105.49
Rate for Payer: WINHealth Partners Commercial $151.85
Rate for Payer: Wise Provider Network Commercial $151.85
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $88.07
Max. Negotiated Rate $159.84
Rate for Payer: Aetna of WY Commercial/Medical Rental $156.64
Rate for Payer: Aetna of WY Medicare $105.49
Rate for Payer: Altius Auto/Workers Compensation $153.45
Rate for Payer: Altius Commercial $153.45
Rate for Payer: Beech Street Commercial $156.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $131.23
Rate for Payer: Cash Price $111.89
Rate for Payer: ChoiceCare Network Commercial $155.04
Rate for Payer: Cigna of WY Commercial $156.64
Rate for Payer: Entrust Commercial $151.85
Rate for Payer: First Choice Health Commercial $151.85
Rate for Payer: Government Employees Health Association (GEHA) Commercial $151.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $92.71
Rate for Payer: HealthUtah PPO $159.84
Rate for Payer: Idaho Integrated Healthcare Commercial $155.04
Rate for Payer: Multiplan Medicare/VA $88.07
Rate for Payer: One Health Plan of WY PPO $156.64
Rate for Payer: PacificSource Commercial $143.86
Rate for Payer: PHCS PPO $156.64
Rate for Payer: Three Rivers PPO $119.88
Rate for Payer: TriWest Veterans Administration $92.71
Rate for Payer: United Healthcare Commercial $139.06
Rate for Payer: United Healthcare Medicare $92.71
Rate for Payer: WINHealth Partners Commercial $156.64
Rate for Payer: Wise Provider Network Commercial $151.85
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $827.33
Max. Negotiated Rate $1,501.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,471.47
Rate for Payer: Aetna of WY Medicare $990.99
Rate for Payer: Altius Auto/Workers Compensation $1,441.44
Rate for Payer: Altius Commercial $1,441.44
Rate for Payer: Beech Street Commercial $1,471.47
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,232.73
Rate for Payer: Cash Price $1,051.05
Rate for Payer: ChoiceCare Network Commercial $1,456.46
Rate for Payer: Cigna of WY Commercial $1,471.47
Rate for Payer: Entrust Commercial $1,426.42
Rate for Payer: First Choice Health Commercial $1,426.42
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,426.42
Rate for Payer: Government Employees Health Association (GEHA) Medicare $870.87
Rate for Payer: HealthUtah PPO $1,501.50
Rate for Payer: Idaho Integrated Healthcare Commercial $1,456.46
Rate for Payer: Multiplan Medicare/VA $827.33
Rate for Payer: One Health Plan of WY PPO $1,471.47
Rate for Payer: PacificSource Commercial $1,351.35
Rate for Payer: PHCS PPO $1,471.47
Rate for Payer: Three Rivers PPO $1,126.12
Rate for Payer: TriWest Veterans Administration $870.87
Rate for Payer: United Healthcare Commercial $1,306.30
Rate for Payer: United Healthcare Medicare $870.87
Rate for Payer: WINHealth Partners Commercial $1,471.47
Rate for Payer: Wise Provider Network Commercial $1,426.42
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $941.44
Max. Negotiated Rate $1,501.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,471.47
Rate for Payer: Altius Auto/Workers Compensation $1,441.44
Rate for Payer: Altius Commercial $1,441.44
Rate for Payer: Beech Street Commercial $1,471.47
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,232.73
Rate for Payer: Cash Price $1,051.05
Rate for Payer: ChoiceCare Network Commercial $1,456.46
Rate for Payer: Cigna of WY Commercial $1,471.47
Rate for Payer: Entrust Commercial $1,426.42
Rate for Payer: First Choice Health Commercial $1,426.42
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,426.42
Rate for Payer: Government Employees Health Association (GEHA) Medicare $990.99
Rate for Payer: HealthUtah PPO $1,501.50
Rate for Payer: Idaho Integrated Healthcare Commercial $1,456.46
Rate for Payer: Multiplan Medicare/VA $941.44
Rate for Payer: One Health Plan of WY PPO $1,471.47
Rate for Payer: PacificSource Commercial $1,351.35
Rate for Payer: PHCS PPO $1,471.47
Rate for Payer: Three Rivers PPO $1,126.12
Rate for Payer: TriWest Veterans Administration $990.99
Rate for Payer: United Healthcare Commercial $1,306.30
Rate for Payer: United Healthcare Medicare $990.99
Rate for Payer: WINHealth Partners Commercial $1,426.42
Rate for Payer: Wise Provider Network Commercial $1,426.42
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $3.79
Max. Negotiated Rate $6.88
Rate for Payer: Aetna of WY Commercial/Medical Rental $6.74
Rate for Payer: Aetna of WY Medicare $4.54
Rate for Payer: Altius Auto/Workers Compensation $6.60
Rate for Payer: Altius Commercial $6.60
Rate for Payer: Beech Street Commercial $6.74
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5.65
Rate for Payer: Cash Price $4.82
Rate for Payer: ChoiceCare Network Commercial $6.67
Rate for Payer: Cigna of WY Commercial $6.74
Rate for Payer: Entrust Commercial $6.54
Rate for Payer: First Choice Health Commercial $6.54
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6.54
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3.99
Rate for Payer: HealthUtah PPO $6.88
Rate for Payer: Idaho Integrated Healthcare Commercial $6.67
Rate for Payer: Multiplan Medicare/VA $3.79
Rate for Payer: One Health Plan of WY PPO $6.74
Rate for Payer: PacificSource Commercial $6.19
Rate for Payer: PHCS PPO $6.74
Rate for Payer: Three Rivers PPO $5.16
Rate for Payer: TriWest Veterans Administration $3.99
Rate for Payer: United Healthcare Commercial $5.99
Rate for Payer: United Healthcare Medicare $3.99
Rate for Payer: WINHealth Partners Commercial $6.74
Rate for Payer: Wise Provider Network Commercial $6.54
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $4.31
Max. Negotiated Rate $6.88
Rate for Payer: Aetna of WY Commercial/Medical Rental $6.74
Rate for Payer: Altius Auto/Workers Compensation $6.60
Rate for Payer: Altius Commercial $6.60
Rate for Payer: Beech Street Commercial $6.74
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $5.65
Rate for Payer: Cash Price $4.82
Rate for Payer: ChoiceCare Network Commercial $6.67
Rate for Payer: Cigna of WY Commercial $6.74
Rate for Payer: Entrust Commercial $6.54
Rate for Payer: First Choice Health Commercial $6.54
Rate for Payer: Government Employees Health Association (GEHA) Commercial $6.54
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4.54
Rate for Payer: HealthUtah PPO $6.88
Rate for Payer: Idaho Integrated Healthcare Commercial $6.67
Rate for Payer: Multiplan Medicare/VA $4.31
Rate for Payer: One Health Plan of WY PPO $6.74
Rate for Payer: PacificSource Commercial $6.19
Rate for Payer: PHCS PPO $6.74
Rate for Payer: Three Rivers PPO $5.16
Rate for Payer: TriWest Veterans Administration $4.54
Rate for Payer: United Healthcare Commercial $5.99
Rate for Payer: United Healthcare Medicare $4.54
Rate for Payer: WINHealth Partners Commercial $6.54
Rate for Payer: Wise Provider Network Commercial $6.54
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $3.31
Max. Negotiated Rate $6.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5.88
Rate for Payer: Aetna of WY Medicare $3.96
Rate for Payer: Altius Auto/Workers Compensation $5.76
Rate for Payer: Altius Commercial $5.76
Rate for Payer: Beech Street Commercial $5.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4.93
Rate for Payer: Cash Price $4.20
Rate for Payer: ChoiceCare Network Commercial $5.82
Rate for Payer: Cigna of WY Commercial $5.88
Rate for Payer: Entrust Commercial $5.70
Rate for Payer: First Choice Health Commercial $5.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3.48
Rate for Payer: HealthUtah PPO $6.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5.82
Rate for Payer: Multiplan Medicare/VA $3.31
Rate for Payer: One Health Plan of WY PPO $5.88
Rate for Payer: PacificSource Commercial $5.40
Rate for Payer: PHCS PPO $5.88
Rate for Payer: Three Rivers PPO $4.50
Rate for Payer: TriWest Veterans Administration $3.48
Rate for Payer: United Healthcare Commercial $5.22
Rate for Payer: United Healthcare Medicare $3.48
Rate for Payer: WINHealth Partners Commercial $5.88
Rate for Payer: Wise Provider Network Commercial $5.70
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $3.76
Max. Negotiated Rate $6.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5.88
Rate for Payer: Altius Auto/Workers Compensation $5.76
Rate for Payer: Altius Commercial $5.76
Rate for Payer: Beech Street Commercial $5.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4.93
Rate for Payer: Cash Price $4.20
Rate for Payer: ChoiceCare Network Commercial $5.82
Rate for Payer: Cigna of WY Commercial $5.88
Rate for Payer: Entrust Commercial $5.70
Rate for Payer: First Choice Health Commercial $5.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3.96
Rate for Payer: HealthUtah PPO $6.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5.82
Rate for Payer: Multiplan Medicare/VA $3.76
Rate for Payer: One Health Plan of WY PPO $5.88
Rate for Payer: PacificSource Commercial $5.40
Rate for Payer: PHCS PPO $5.88
Rate for Payer: Three Rivers PPO $4.50
Rate for Payer: TriWest Veterans Administration $3.96
Rate for Payer: United Healthcare Commercial $5.22
Rate for Payer: United Healthcare Medicare $3.96
Rate for Payer: WINHealth Partners Commercial $5.70
Rate for Payer: Wise Provider Network Commercial $5.70
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $3.60
Max. Negotiated Rate $5.74
Rate for Payer: Aetna of WY Commercial/Medical Rental $5.63
Rate for Payer: Altius Auto/Workers Compensation $5.51
Rate for Payer: Altius Commercial $5.51
Rate for Payer: Beech Street Commercial $5.63
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4.71
Rate for Payer: Cash Price $4.02
Rate for Payer: ChoiceCare Network Commercial $5.57
Rate for Payer: Cigna of WY Commercial $5.63
Rate for Payer: Entrust Commercial $5.45
Rate for Payer: First Choice Health Commercial $5.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3.79
Rate for Payer: HealthUtah PPO $5.74
Rate for Payer: Idaho Integrated Healthcare Commercial $5.57
Rate for Payer: Multiplan Medicare/VA $3.60
Rate for Payer: One Health Plan of WY PPO $5.63
Rate for Payer: PacificSource Commercial $5.17
Rate for Payer: PHCS PPO $5.63
Rate for Payer: Three Rivers PPO $4.30
Rate for Payer: TriWest Veterans Administration $3.79
Rate for Payer: United Healthcare Commercial $4.99
Rate for Payer: United Healthcare Medicare $3.79
Rate for Payer: WINHealth Partners Commercial $5.45
Rate for Payer: Wise Provider Network Commercial $5.45
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $3.16
Max. Negotiated Rate $5.74
Rate for Payer: Aetna of WY Commercial/Medical Rental $5.63
Rate for Payer: Aetna of WY Medicare $3.79
Rate for Payer: Altius Auto/Workers Compensation $5.51
Rate for Payer: Altius Commercial $5.51
Rate for Payer: Beech Street Commercial $5.63
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4.71
Rate for Payer: Cash Price $4.02
Rate for Payer: ChoiceCare Network Commercial $5.57
Rate for Payer: Cigna of WY Commercial $5.63
Rate for Payer: Entrust Commercial $5.45
Rate for Payer: First Choice Health Commercial $5.45
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3.33
Rate for Payer: HealthUtah PPO $5.74
Rate for Payer: Idaho Integrated Healthcare Commercial $5.57
Rate for Payer: Multiplan Medicare/VA $3.16
Rate for Payer: One Health Plan of WY PPO $5.63
Rate for Payer: PacificSource Commercial $5.17
Rate for Payer: PHCS PPO $5.63
Rate for Payer: Three Rivers PPO $4.30
Rate for Payer: TriWest Veterans Administration $3.33
Rate for Payer: United Healthcare Commercial $4.99
Rate for Payer: United Healthcare Medicare $3.33
Rate for Payer: WINHealth Partners Commercial $5.63
Rate for Payer: Wise Provider Network Commercial $5.45
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $140.60
Max. Negotiated Rate $224.24
Rate for Payer: Aetna of WY Commercial/Medical Rental $219.76
Rate for Payer: Altius Auto/Workers Compensation $215.27
Rate for Payer: Altius Commercial $215.27
Rate for Payer: Beech Street Commercial $219.76
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $184.10
Rate for Payer: Cash Price $156.97
Rate for Payer: ChoiceCare Network Commercial $217.51
Rate for Payer: Cigna of WY Commercial $219.76
Rate for Payer: Entrust Commercial $213.03
Rate for Payer: First Choice Health Commercial $213.03
Rate for Payer: Government Employees Health Association (GEHA) Commercial $213.03
Rate for Payer: Government Employees Health Association (GEHA) Medicare $148.00
Rate for Payer: HealthUtah PPO $224.24
Rate for Payer: Idaho Integrated Healthcare Commercial $217.51
Rate for Payer: Multiplan Medicare/VA $140.60
Rate for Payer: One Health Plan of WY PPO $219.76
Rate for Payer: PacificSource Commercial $201.82
Rate for Payer: PHCS PPO $219.76
Rate for Payer: Three Rivers PPO $168.18
Rate for Payer: TriWest Veterans Administration $148.00
Rate for Payer: United Healthcare Commercial $195.09
Rate for Payer: United Healthcare Medicare $148.00
Rate for Payer: WINHealth Partners Commercial $213.03
Rate for Payer: Wise Provider Network Commercial $213.03
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $123.56
Max. Negotiated Rate $224.24
Rate for Payer: Aetna of WY Commercial/Medical Rental $219.76
Rate for Payer: Aetna of WY Medicare $148.00
Rate for Payer: Altius Auto/Workers Compensation $215.27
Rate for Payer: Altius Commercial $215.27
Rate for Payer: Beech Street Commercial $219.76
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $184.10
Rate for Payer: Cash Price $156.97
Rate for Payer: ChoiceCare Network Commercial $217.51
Rate for Payer: Cigna of WY Commercial $219.76
Rate for Payer: Entrust Commercial $213.03
Rate for Payer: First Choice Health Commercial $213.03
Rate for Payer: Government Employees Health Association (GEHA) Commercial $213.03
Rate for Payer: Government Employees Health Association (GEHA) Medicare $130.06
Rate for Payer: HealthUtah PPO $224.24
Rate for Payer: Idaho Integrated Healthcare Commercial $217.51
Rate for Payer: Multiplan Medicare/VA $123.56
Rate for Payer: One Health Plan of WY PPO $219.76
Rate for Payer: PacificSource Commercial $201.82
Rate for Payer: PHCS PPO $219.76
Rate for Payer: Three Rivers PPO $168.18
Rate for Payer: TriWest Veterans Administration $130.06
Rate for Payer: United Healthcare Commercial $195.09
Rate for Payer: United Healthcare Medicare $130.06
Rate for Payer: WINHealth Partners Commercial $219.76
Rate for Payer: Wise Provider Network Commercial $213.03
Service Code HCPCS J9267
Hospital Revenue Code 636
Min. Negotiated Rate $12.98
Max. Negotiated Rate $20.70
Rate for Payer: Aetna of WY Commercial/Medical Rental $20.29
Rate for Payer: Aetna of WY Commercial/Medical Rental $22.54
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.21
Rate for Payer: Altius Auto/Workers Compensation $19.87
Rate for Payer: Altius Auto/Workers Compensation $22.08
Rate for Payer: Altius Auto/Workers Compensation $23.71
Rate for Payer: Altius Commercial $22.08
Rate for Payer: Altius Commercial $19.87
Rate for Payer: Altius Commercial $23.71
Rate for Payer: Beech Street Commercial $24.21
Rate for Payer: Beech Street Commercial $22.54
Rate for Payer: Beech Street Commercial $20.29
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.99
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.28
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $18.88
Rate for Payer: Cash Price $16.10
Rate for Payer: Cash Price $14.49
Rate for Payer: Cash Price $17.29
Rate for Payer: ChoiceCare Network Commercial $20.08
Rate for Payer: ChoiceCare Network Commercial $23.96
Rate for Payer: ChoiceCare Network Commercial $22.31
Rate for Payer: Cigna of WY Commercial $22.54
Rate for Payer: Cigna of WY Commercial $24.21
Rate for Payer: Cigna of WY Commercial $20.29
Rate for Payer: Entrust Commercial $23.46
Rate for Payer: Entrust Commercial $19.66
Rate for Payer: Entrust Commercial $21.85
Rate for Payer: First Choice Health Commercial $21.85
Rate for Payer: First Choice Health Commercial $23.46
Rate for Payer: First Choice Health Commercial $19.66
Rate for Payer: Government Employees Health Association (GEHA) Commercial $19.66
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $21.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $13.66
Rate for Payer: Government Employees Health Association (GEHA) Medicare $15.18
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.30
Rate for Payer: HealthUtah PPO $20.70
Rate for Payer: HealthUtah PPO $23.00
Rate for Payer: HealthUtah PPO $24.70
Rate for Payer: Idaho Integrated Healthcare Commercial $23.96
Rate for Payer: Idaho Integrated Healthcare Commercial $22.31
Rate for Payer: Idaho Integrated Healthcare Commercial $20.08
Rate for Payer: Multiplan Medicare/VA $15.49
Rate for Payer: Multiplan Medicare/VA $12.98
Rate for Payer: Multiplan Medicare/VA $14.42
Rate for Payer: One Health Plan of WY PPO $20.29
Rate for Payer: One Health Plan of WY PPO $22.54
Rate for Payer: One Health Plan of WY PPO $24.21
Rate for Payer: PacificSource Commercial $22.23
Rate for Payer: PacificSource Commercial $18.63
Rate for Payer: PacificSource Commercial $20.70
Rate for Payer: PHCS PPO $22.54
Rate for Payer: PHCS PPO $20.29
Rate for Payer: PHCS PPO $24.21
Rate for Payer: Three Rivers PPO $17.25
Rate for Payer: Three Rivers PPO $15.52
Rate for Payer: Three Rivers PPO $18.52
Rate for Payer: TriWest Veterans Administration $15.18
Rate for Payer: TriWest Veterans Administration $13.66
Rate for Payer: TriWest Veterans Administration $16.30
Rate for Payer: United Healthcare Commercial $18.01
Rate for Payer: United Healthcare Commercial $21.49
Rate for Payer: United Healthcare Commercial $20.01
Rate for Payer: United Healthcare Medicare $13.66
Rate for Payer: United Healthcare Medicare $16.30
Rate for Payer: United Healthcare Medicare $15.18
Rate for Payer: WINHealth Partners Commercial $21.85
Rate for Payer: WINHealth Partners Commercial $19.66
Rate for Payer: WINHealth Partners Commercial $23.46
Rate for Payer: Wise Provider Network Commercial $23.46
Rate for Payer: Wise Provider Network Commercial $19.66
Rate for Payer: Wise Provider Network Commercial $21.85
Service Code HCPCS J9267
Hospital Revenue Code 636
Min. Negotiated Rate $12.67
Max. Negotiated Rate $23.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $22.54
Rate for Payer: Aetna of WY Commercial/Medical Rental $20.29
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.21
Rate for Payer: Aetna of WY Medicare $15.18
Rate for Payer: Aetna of WY Medicare $16.30
Rate for Payer: Aetna of WY Medicare $13.66
Rate for Payer: Altius Auto/Workers Compensation $22.08
Rate for Payer: Altius Auto/Workers Compensation $19.87
Rate for Payer: Altius Auto/Workers Compensation $23.71
Rate for Payer: Altius Commercial $22.08
Rate for Payer: Altius Commercial $23.71
Rate for Payer: Altius Commercial $19.87
Rate for Payer: Beech Street Commercial $22.54
Rate for Payer: Beech Street Commercial $24.21
Rate for Payer: Beech Street Commercial $20.29
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $18.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.99
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.28
Rate for Payer: Cash Price $16.10
Rate for Payer: Cash Price $14.49
Rate for Payer: Cash Price $17.29
Rate for Payer: ChoiceCare Network Commercial $22.31
Rate for Payer: ChoiceCare Network Commercial $23.96
Rate for Payer: ChoiceCare Network Commercial $20.08
Rate for Payer: Cigna of WY Commercial $24.21
Rate for Payer: Cigna of WY Commercial $20.29
Rate for Payer: Cigna of WY Commercial $22.54
Rate for Payer: Entrust Commercial $23.46
Rate for Payer: Entrust Commercial $21.85
Rate for Payer: Entrust Commercial $19.66
Rate for Payer: First Choice Health Commercial $21.85
Rate for Payer: First Choice Health Commercial $19.66
Rate for Payer: First Choice Health Commercial $23.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $19.66
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $21.85
Rate for Payer: Government Employees Health Association (GEHA) Medicare $13.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $12.01
Rate for Payer: Government Employees Health Association (GEHA) Medicare $14.33
Rate for Payer: HealthUtah PPO $20.70
Rate for Payer: HealthUtah PPO $24.70
Rate for Payer: HealthUtah PPO $23.00
Rate for Payer: Idaho Integrated Healthcare Commercial $23.96
Rate for Payer: Idaho Integrated Healthcare Commercial $20.08
Rate for Payer: Idaho Integrated Healthcare Commercial $22.31
Rate for Payer: Multiplan Medicare/VA $11.41
Rate for Payer: Multiplan Medicare/VA $12.67
Rate for Payer: Multiplan Medicare/VA $13.61
Rate for Payer: One Health Plan of WY PPO $20.29
Rate for Payer: One Health Plan of WY PPO $24.21
Rate for Payer: One Health Plan of WY PPO $22.54
Rate for Payer: PacificSource Commercial $22.23
Rate for Payer: PacificSource Commercial $20.70
Rate for Payer: PacificSource Commercial $18.63
Rate for Payer: PHCS PPO $22.54
Rate for Payer: PHCS PPO $20.29
Rate for Payer: PHCS PPO $24.21
Rate for Payer: Three Rivers PPO $17.25
Rate for Payer: Three Rivers PPO $15.52
Rate for Payer: Three Rivers PPO $18.52
Rate for Payer: TriWest Veterans Administration $14.33
Rate for Payer: TriWest Veterans Administration $13.34
Rate for Payer: TriWest Veterans Administration $12.01
Rate for Payer: United Healthcare Commercial $18.01
Rate for Payer: United Healthcare Commercial $20.01
Rate for Payer: United Healthcare Commercial $21.49
Rate for Payer: United Healthcare Medicare $14.33
Rate for Payer: United Healthcare Medicare $12.01
Rate for Payer: United Healthcare Medicare $13.34
Rate for Payer: WINHealth Partners Commercial $24.21
Rate for Payer: WINHealth Partners Commercial $20.29
Rate for Payer: WINHealth Partners Commercial $22.54
Rate for Payer: Wise Provider Network Commercial $19.66
Rate for Payer: Wise Provider Network Commercial $23.46
Rate for Payer: Wise Provider Network Commercial $21.85
Service Code HCPCS J9264
Hospital Revenue Code 636
Min. Negotiated Rate $878.88
Max. Negotiated Rate $1,595.06
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,563.16
Rate for Payer: Aetna of WY Medicare $1,052.74
Rate for Payer: Altius Auto/Workers Compensation $1,531.26
Rate for Payer: Altius Commercial $1,531.26
Rate for Payer: Beech Street Commercial $1,563.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,309.54
Rate for Payer: Cash Price $1,116.54
Rate for Payer: ChoiceCare Network Commercial $1,547.21
Rate for Payer: Cigna of WY Commercial $1,563.16
Rate for Payer: Entrust Commercial $1,515.31
Rate for Payer: First Choice Health Commercial $1,515.31
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,515.31
Rate for Payer: Government Employees Health Association (GEHA) Medicare $925.13
Rate for Payer: HealthUtah PPO $1,595.06
Rate for Payer: Idaho Integrated Healthcare Commercial $1,547.21
Rate for Payer: Multiplan Medicare/VA $878.88
Rate for Payer: One Health Plan of WY PPO $1,563.16
Rate for Payer: PacificSource Commercial $1,435.55
Rate for Payer: PHCS PPO $1,563.16
Rate for Payer: Three Rivers PPO $1,196.30
Rate for Payer: TriWest Veterans Administration $925.13
Rate for Payer: United Healthcare Commercial $1,387.70
Rate for Payer: United Healthcare Medicare $925.13
Rate for Payer: WINHealth Partners Commercial $1,563.16
Rate for Payer: Wise Provider Network Commercial $1,515.31