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Service Code NDC 5026876615
Hospital Revenue Code 250
Min. Negotiated Rate $2.11
Max. Negotiated Rate $3.36
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.29
Rate for Payer: Altius Auto/Workers Compensation $3.23
Rate for Payer: Altius Commercial $3.23
Rate for Payer: Beech Street Commercial $3.29
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.76
Rate for Payer: Cash Price $2.36
Rate for Payer: ChoiceCare Network Commercial $3.26
Rate for Payer: Cigna of WY Commercial $3.29
Rate for Payer: Entrust Commercial $3.19
Rate for Payer: First Choice Health Commercial $3.19
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.19
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2.22
Rate for Payer: HealthUtah PPO $3.36
Rate for Payer: Idaho Integrated Healthcare Commercial $3.26
Rate for Payer: Multiplan Medicare/VA $2.11
Rate for Payer: One Health Plan of WY PPO $3.29
Rate for Payer: PacificSource Commercial $3.02
Rate for Payer: PHCS PPO $3.29
Rate for Payer: Three Rivers PPO $2.52
Rate for Payer: TriWest Veterans Administration $2.22
Rate for Payer: United Healthcare Commercial $2.92
Rate for Payer: United Healthcare Medicare $2.22
Rate for Payer: WINHealth Partners Commercial $3.19
Rate for Payer: Wise Provider Network Commercial $3.19
Service Code NDC 5026876615
Hospital Revenue Code 250
Min. Negotiated Rate $1.85
Max. Negotiated Rate $3.36
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.29
Rate for Payer: Aetna of WY Medicare $2.22
Rate for Payer: Altius Auto/Workers Compensation $3.23
Rate for Payer: Altius Commercial $3.23
Rate for Payer: Beech Street Commercial $3.29
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.76
Rate for Payer: Cash Price $2.36
Rate for Payer: ChoiceCare Network Commercial $3.26
Rate for Payer: Cigna of WY Commercial $3.29
Rate for Payer: Entrust Commercial $3.19
Rate for Payer: First Choice Health Commercial $3.19
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.19
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.95
Rate for Payer: HealthUtah PPO $3.36
Rate for Payer: Idaho Integrated Healthcare Commercial $3.26
Rate for Payer: Multiplan Medicare/VA $1.85
Rate for Payer: One Health Plan of WY PPO $3.29
Rate for Payer: PacificSource Commercial $3.02
Rate for Payer: PHCS PPO $3.29
Rate for Payer: Three Rivers PPO $2.52
Rate for Payer: TriWest Veterans Administration $1.95
Rate for Payer: United Healthcare Commercial $2.92
Rate for Payer: United Healthcare Medicare $1.95
Rate for Payer: WINHealth Partners Commercial $3.29
Rate for Payer: Wise Provider Network Commercial $3.19
Service Code NDC 2438552403
Hospital Revenue Code 250
Min. Negotiated Rate $0.88
Max. Negotiated Rate $1.41
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.38
Rate for Payer: Altius Auto/Workers Compensation $1.35
Rate for Payer: Altius Commercial $1.35
Rate for Payer: Beech Street Commercial $1.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.16
Rate for Payer: Cash Price $0.99
Rate for Payer: ChoiceCare Network Commercial $1.37
Rate for Payer: Cigna of WY Commercial $1.38
Rate for Payer: Entrust Commercial $1.34
Rate for Payer: First Choice Health Commercial $1.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.93
Rate for Payer: HealthUtah PPO $1.41
Rate for Payer: Idaho Integrated Healthcare Commercial $1.37
Rate for Payer: Multiplan Medicare/VA $0.88
Rate for Payer: One Health Plan of WY PPO $1.38
Rate for Payer: PacificSource Commercial $1.27
Rate for Payer: PHCS PPO $1.38
Rate for Payer: Three Rivers PPO $1.06
Rate for Payer: TriWest Veterans Administration $0.93
Rate for Payer: United Healthcare Commercial $1.23
Rate for Payer: United Healthcare Medicare $0.93
Rate for Payer: WINHealth Partners Commercial $1.34
Rate for Payer: Wise Provider Network Commercial $1.34
Service Code NDC 2438552403
Hospital Revenue Code 250
Min. Negotiated Rate $0.78
Max. Negotiated Rate $1.41
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.38
Rate for Payer: Aetna of WY Medicare $0.93
Rate for Payer: Altius Auto/Workers Compensation $1.35
Rate for Payer: Altius Commercial $1.35
Rate for Payer: Beech Street Commercial $1.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.16
Rate for Payer: Cash Price $0.99
Rate for Payer: ChoiceCare Network Commercial $1.37
Rate for Payer: Cigna of WY Commercial $1.38
Rate for Payer: Entrust Commercial $1.34
Rate for Payer: First Choice Health Commercial $1.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.82
Rate for Payer: HealthUtah PPO $1.41
Rate for Payer: Idaho Integrated Healthcare Commercial $1.37
Rate for Payer: Multiplan Medicare/VA $0.78
Rate for Payer: One Health Plan of WY PPO $1.38
Rate for Payer: PacificSource Commercial $1.27
Rate for Payer: PHCS PPO $1.38
Rate for Payer: Three Rivers PPO $1.06
Rate for Payer: TriWest Veterans Administration $0.82
Rate for Payer: United Healthcare Commercial $1.23
Rate for Payer: United Healthcare Medicare $0.82
Rate for Payer: WINHealth Partners Commercial $1.38
Rate for Payer: Wise Provider Network Commercial $1.34
Service Code NDC 6586207930
Hospital Revenue Code 250
Min. Negotiated Rate $0.63
Max. Negotiated Rate $1.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.98
Rate for Payer: Altius Auto/Workers Compensation $0.96
Rate for Payer: Altius Commercial $0.96
Rate for Payer: Beech Street Commercial $0.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.82
Rate for Payer: Cash Price $0.70
Rate for Payer: ChoiceCare Network Commercial $0.97
Rate for Payer: Cigna of WY Commercial $0.98
Rate for Payer: Entrust Commercial $0.95
Rate for Payer: First Choice Health Commercial $0.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.66
Rate for Payer: HealthUtah PPO $1.00
Rate for Payer: Idaho Integrated Healthcare Commercial $0.97
Rate for Payer: Multiplan Medicare/VA $0.63
Rate for Payer: One Health Plan of WY PPO $0.98
Rate for Payer: PacificSource Commercial $0.90
Rate for Payer: PHCS PPO $0.98
Rate for Payer: Three Rivers PPO $0.75
Rate for Payer: TriWest Veterans Administration $0.66
Rate for Payer: United Healthcare Commercial $0.87
Rate for Payer: United Healthcare Medicare $0.66
Rate for Payer: WINHealth Partners Commercial $0.95
Rate for Payer: Wise Provider Network Commercial $0.95
Service Code NDC 6586207930
Hospital Revenue Code 250
Min. Negotiated Rate $0.55
Max. Negotiated Rate $1.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.98
Rate for Payer: Aetna of WY Medicare $0.66
Rate for Payer: Altius Auto/Workers Compensation $0.96
Rate for Payer: Altius Commercial $0.96
Rate for Payer: Beech Street Commercial $0.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.82
Rate for Payer: Cash Price $0.70
Rate for Payer: ChoiceCare Network Commercial $0.97
Rate for Payer: Cigna of WY Commercial $0.98
Rate for Payer: Entrust Commercial $0.95
Rate for Payer: First Choice Health Commercial $0.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.58
Rate for Payer: HealthUtah PPO $1.00
Rate for Payer: Idaho Integrated Healthcare Commercial $0.97
Rate for Payer: Multiplan Medicare/VA $0.55
Rate for Payer: One Health Plan of WY PPO $0.98
Rate for Payer: PacificSource Commercial $0.90
Rate for Payer: PHCS PPO $0.98
Rate for Payer: Three Rivers PPO $0.75
Rate for Payer: TriWest Veterans Administration $0.58
Rate for Payer: United Healthcare Commercial $0.87
Rate for Payer: United Healthcare Medicare $0.58
Rate for Payer: WINHealth Partners Commercial $0.98
Rate for Payer: Wise Provider Network Commercial $0.95
Service Code HCPCS J3105
Hospital Revenue Code 636
Min. Negotiated Rate $18.81
Max. Negotiated Rate $30.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $29.40
Rate for Payer: Altius Auto/Workers Compensation $28.80
Rate for Payer: Altius Commercial $28.80
Rate for Payer: Beech Street Commercial $29.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $24.63
Rate for Payer: Cash Price $21.00
Rate for Payer: ChoiceCare Network Commercial $29.10
Rate for Payer: Cigna of WY Commercial $29.40
Rate for Payer: Entrust Commercial $28.50
Rate for Payer: First Choice Health Commercial $28.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $28.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $19.80
Rate for Payer: HealthUtah PPO $30.00
Rate for Payer: Idaho Integrated Healthcare Commercial $29.10
Rate for Payer: Multiplan Medicare/VA $18.81
Rate for Payer: One Health Plan of WY PPO $29.40
Rate for Payer: PacificSource Commercial $27.00
Rate for Payer: PHCS PPO $29.40
Rate for Payer: Three Rivers PPO $22.50
Rate for Payer: TriWest Veterans Administration $19.80
Rate for Payer: United Healthcare Commercial $26.10
Rate for Payer: United Healthcare Medicare $19.80
Rate for Payer: WINHealth Partners Commercial $28.50
Rate for Payer: Wise Provider Network Commercial $28.50
Service Code HCPCS J3105
Hospital Revenue Code 636
Min. Negotiated Rate $16.53
Max. Negotiated Rate $30.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $29.40
Rate for Payer: Aetna of WY Medicare $19.80
Rate for Payer: Altius Auto/Workers Compensation $28.80
Rate for Payer: Altius Commercial $28.80
Rate for Payer: Beech Street Commercial $29.40
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $24.63
Rate for Payer: Cash Price $21.00
Rate for Payer: ChoiceCare Network Commercial $29.10
Rate for Payer: Cigna of WY Commercial $29.40
Rate for Payer: Entrust Commercial $28.50
Rate for Payer: First Choice Health Commercial $28.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $28.50
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.40
Rate for Payer: HealthUtah PPO $30.00
Rate for Payer: Idaho Integrated Healthcare Commercial $29.10
Rate for Payer: Multiplan Medicare/VA $16.53
Rate for Payer: One Health Plan of WY PPO $29.40
Rate for Payer: PacificSource Commercial $27.00
Rate for Payer: PHCS PPO $29.40
Rate for Payer: Three Rivers PPO $22.50
Rate for Payer: TriWest Veterans Administration $17.40
Rate for Payer: United Healthcare Commercial $26.10
Rate for Payer: United Healthcare Medicare $17.40
Rate for Payer: WINHealth Partners Commercial $29.40
Rate for Payer: Wise Provider Network Commercial $28.50
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $548.62
Max. Negotiated Rate $875.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $857.50
Rate for Payer: Altius Auto/Workers Compensation $840.00
Rate for Payer: Altius Commercial $840.00
Rate for Payer: Beech Street Commercial $857.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $718.38
Rate for Payer: Cash Price $612.50
Rate for Payer: ChoiceCare Network Commercial $848.75
Rate for Payer: Cigna of WY Commercial $857.50
Rate for Payer: Entrust Commercial $831.25
Rate for Payer: First Choice Health Commercial $831.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $831.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $577.50
Rate for Payer: HealthUtah PPO $875.00
Rate for Payer: Idaho Integrated Healthcare Commercial $848.75
Rate for Payer: Multiplan Medicare/VA $548.62
Rate for Payer: One Health Plan of WY PPO $857.50
Rate for Payer: PacificSource Commercial $787.50
Rate for Payer: PHCS PPO $857.50
Rate for Payer: Three Rivers PPO $656.25
Rate for Payer: TriWest Veterans Administration $577.50
Rate for Payer: United Healthcare Commercial $761.25
Rate for Payer: United Healthcare Medicare $577.50
Rate for Payer: WINHealth Partners Commercial $831.25
Rate for Payer: Wise Provider Network Commercial $831.25
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $482.12
Max. Negotiated Rate $875.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $857.50
Rate for Payer: Aetna of WY Medicare $577.50
Rate for Payer: Altius Auto/Workers Compensation $840.00
Rate for Payer: Altius Commercial $840.00
Rate for Payer: Beech Street Commercial $857.50
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $718.38
Rate for Payer: Cash Price $612.50
Rate for Payer: ChoiceCare Network Commercial $848.75
Rate for Payer: Cigna of WY Commercial $857.50
Rate for Payer: Entrust Commercial $831.25
Rate for Payer: First Choice Health Commercial $831.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $831.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $507.50
Rate for Payer: HealthUtah PPO $875.00
Rate for Payer: Idaho Integrated Healthcare Commercial $848.75
Rate for Payer: Multiplan Medicare/VA $482.12
Rate for Payer: One Health Plan of WY PPO $857.50
Rate for Payer: PacificSource Commercial $787.50
Rate for Payer: PHCS PPO $857.50
Rate for Payer: Three Rivers PPO $656.25
Rate for Payer: TriWest Veterans Administration $507.50
Rate for Payer: United Healthcare Commercial $761.25
Rate for Payer: United Healthcare Medicare $507.50
Rate for Payer: WINHealth Partners Commercial $857.50
Rate for Payer: Wise Provider Network Commercial $831.25
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $902.54
Max. Negotiated Rate $1,638.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,605.24
Rate for Payer: Aetna of WY Medicare $1,081.08
Rate for Payer: Altius Auto/Workers Compensation $1,572.48
Rate for Payer: Altius Commercial $1,572.48
Rate for Payer: Beech Street Commercial $1,605.24
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,344.80
Rate for Payer: Cash Price $1,146.60
Rate for Payer: ChoiceCare Network Commercial $1,588.86
Rate for Payer: Cigna of WY Commercial $1,605.24
Rate for Payer: Entrust Commercial $1,556.10
Rate for Payer: First Choice Health Commercial $1,556.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,556.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $950.04
Rate for Payer: HealthUtah PPO $1,638.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,588.86
Rate for Payer: Multiplan Medicare/VA $902.54
Rate for Payer: One Health Plan of WY PPO $1,605.24
Rate for Payer: PacificSource Commercial $1,474.20
Rate for Payer: PHCS PPO $1,605.24
Rate for Payer: Three Rivers PPO $1,228.50
Rate for Payer: TriWest Veterans Administration $950.04
Rate for Payer: United Healthcare Commercial $1,425.06
Rate for Payer: United Healthcare Medicare $950.04
Rate for Payer: WINHealth Partners Commercial $1,605.24
Rate for Payer: Wise Provider Network Commercial $1,556.10
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $1,027.03
Max. Negotiated Rate $1,638.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,605.24
Rate for Payer: Altius Auto/Workers Compensation $1,572.48
Rate for Payer: Altius Commercial $1,572.48
Rate for Payer: Beech Street Commercial $1,605.24
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,344.80
Rate for Payer: Cash Price $1,146.60
Rate for Payer: ChoiceCare Network Commercial $1,588.86
Rate for Payer: Cigna of WY Commercial $1,605.24
Rate for Payer: Entrust Commercial $1,556.10
Rate for Payer: First Choice Health Commercial $1,556.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,556.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,081.08
Rate for Payer: HealthUtah PPO $1,638.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,588.86
Rate for Payer: Multiplan Medicare/VA $1,027.03
Rate for Payer: One Health Plan of WY PPO $1,605.24
Rate for Payer: PacificSource Commercial $1,474.20
Rate for Payer: PHCS PPO $1,605.24
Rate for Payer: Three Rivers PPO $1,228.50
Rate for Payer: TriWest Veterans Administration $1,081.08
Rate for Payer: United Healthcare Commercial $1,425.06
Rate for Payer: United Healthcare Medicare $1,081.08
Rate for Payer: WINHealth Partners Commercial $1,556.10
Rate for Payer: Wise Provider Network Commercial $1,556.10
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $155.81
Max. Negotiated Rate $248.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $243.53
Rate for Payer: Altius Auto/Workers Compensation $238.56
Rate for Payer: Altius Commercial $238.56
Rate for Payer: Beech Street Commercial $243.53
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $204.02
Rate for Payer: Cash Price $173.95
Rate for Payer: ChoiceCare Network Commercial $241.04
Rate for Payer: Cigna of WY Commercial $243.53
Rate for Payer: Entrust Commercial $236.08
Rate for Payer: First Choice Health Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $164.01
Rate for Payer: HealthUtah PPO $248.50
Rate for Payer: Idaho Integrated Healthcare Commercial $241.04
Rate for Payer: Multiplan Medicare/VA $155.81
Rate for Payer: One Health Plan of WY PPO $243.53
Rate for Payer: PacificSource Commercial $223.65
Rate for Payer: PHCS PPO $243.53
Rate for Payer: Three Rivers PPO $186.38
Rate for Payer: TriWest Veterans Administration $164.01
Rate for Payer: United Healthcare Commercial $216.20
Rate for Payer: United Healthcare Medicare $164.01
Rate for Payer: WINHealth Partners Commercial $236.08
Rate for Payer: Wise Provider Network Commercial $236.08
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $136.92
Max. Negotiated Rate $248.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $243.53
Rate for Payer: Aetna of WY Medicare $164.01
Rate for Payer: Altius Auto/Workers Compensation $238.56
Rate for Payer: Altius Commercial $238.56
Rate for Payer: Beech Street Commercial $243.53
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $204.02
Rate for Payer: Cash Price $173.95
Rate for Payer: ChoiceCare Network Commercial $241.04
Rate for Payer: Cigna of WY Commercial $243.53
Rate for Payer: Entrust Commercial $236.08
Rate for Payer: First Choice Health Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $144.13
Rate for Payer: HealthUtah PPO $248.50
Rate for Payer: Idaho Integrated Healthcare Commercial $241.04
Rate for Payer: Multiplan Medicare/VA $136.92
Rate for Payer: One Health Plan of WY PPO $243.53
Rate for Payer: PacificSource Commercial $223.65
Rate for Payer: PHCS PPO $243.53
Rate for Payer: Three Rivers PPO $186.38
Rate for Payer: TriWest Veterans Administration $144.13
Rate for Payer: United Healthcare Commercial $216.20
Rate for Payer: United Healthcare Medicare $144.13
Rate for Payer: WINHealth Partners Commercial $243.53
Rate for Payer: Wise Provider Network Commercial $236.08
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $155.81
Max. Negotiated Rate $248.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $243.53
Rate for Payer: Altius Auto/Workers Compensation $238.56
Rate for Payer: Altius Commercial $238.56
Rate for Payer: Beech Street Commercial $243.53
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $204.02
Rate for Payer: Cash Price $173.95
Rate for Payer: ChoiceCare Network Commercial $241.04
Rate for Payer: Cigna of WY Commercial $243.53
Rate for Payer: Entrust Commercial $236.08
Rate for Payer: First Choice Health Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $164.01
Rate for Payer: HealthUtah PPO $248.50
Rate for Payer: Idaho Integrated Healthcare Commercial $241.04
Rate for Payer: Multiplan Medicare/VA $155.81
Rate for Payer: One Health Plan of WY PPO $243.53
Rate for Payer: PacificSource Commercial $223.65
Rate for Payer: PHCS PPO $243.53
Rate for Payer: Three Rivers PPO $186.38
Rate for Payer: TriWest Veterans Administration $164.01
Rate for Payer: United Healthcare Commercial $216.20
Rate for Payer: United Healthcare Medicare $164.01
Rate for Payer: WINHealth Partners Commercial $236.08
Rate for Payer: Wise Provider Network Commercial $236.08
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $136.92
Max. Negotiated Rate $248.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $243.53
Rate for Payer: Aetna of WY Medicare $164.01
Rate for Payer: Altius Auto/Workers Compensation $238.56
Rate for Payer: Altius Commercial $238.56
Rate for Payer: Beech Street Commercial $243.53
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $204.02
Rate for Payer: Cash Price $173.95
Rate for Payer: ChoiceCare Network Commercial $241.04
Rate for Payer: Cigna of WY Commercial $243.53
Rate for Payer: Entrust Commercial $236.08
Rate for Payer: First Choice Health Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $144.13
Rate for Payer: HealthUtah PPO $248.50
Rate for Payer: Idaho Integrated Healthcare Commercial $241.04
Rate for Payer: Multiplan Medicare/VA $136.92
Rate for Payer: One Health Plan of WY PPO $243.53
Rate for Payer: PacificSource Commercial $223.65
Rate for Payer: PHCS PPO $243.53
Rate for Payer: Three Rivers PPO $186.38
Rate for Payer: TriWest Veterans Administration $144.13
Rate for Payer: United Healthcare Commercial $216.20
Rate for Payer: United Healthcare Medicare $144.13
Rate for Payer: WINHealth Partners Commercial $243.53
Rate for Payer: Wise Provider Network Commercial $236.08
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $136.92
Max. Negotiated Rate $248.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $243.53
Rate for Payer: Aetna of WY Medicare $164.01
Rate for Payer: Altius Auto/Workers Compensation $238.56
Rate for Payer: Altius Commercial $238.56
Rate for Payer: Beech Street Commercial $243.53
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $204.02
Rate for Payer: Cash Price $173.95
Rate for Payer: ChoiceCare Network Commercial $241.04
Rate for Payer: Cigna of WY Commercial $243.53
Rate for Payer: Entrust Commercial $236.08
Rate for Payer: First Choice Health Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $144.13
Rate for Payer: HealthUtah PPO $248.50
Rate for Payer: Idaho Integrated Healthcare Commercial $241.04
Rate for Payer: Multiplan Medicare/VA $136.92
Rate for Payer: One Health Plan of WY PPO $243.53
Rate for Payer: PacificSource Commercial $223.65
Rate for Payer: PHCS PPO $243.53
Rate for Payer: Three Rivers PPO $186.38
Rate for Payer: TriWest Veterans Administration $144.13
Rate for Payer: United Healthcare Commercial $216.20
Rate for Payer: United Healthcare Medicare $144.13
Rate for Payer: WINHealth Partners Commercial $243.53
Rate for Payer: Wise Provider Network Commercial $236.08
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $155.81
Max. Negotiated Rate $248.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $243.53
Rate for Payer: Altius Auto/Workers Compensation $238.56
Rate for Payer: Altius Commercial $238.56
Rate for Payer: Beech Street Commercial $243.53
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $204.02
Rate for Payer: Cash Price $173.95
Rate for Payer: ChoiceCare Network Commercial $241.04
Rate for Payer: Cigna of WY Commercial $243.53
Rate for Payer: Entrust Commercial $236.08
Rate for Payer: First Choice Health Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $236.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $164.01
Rate for Payer: HealthUtah PPO $248.50
Rate for Payer: Idaho Integrated Healthcare Commercial $241.04
Rate for Payer: Multiplan Medicare/VA $155.81
Rate for Payer: One Health Plan of WY PPO $243.53
Rate for Payer: PacificSource Commercial $223.65
Rate for Payer: PHCS PPO $243.53
Rate for Payer: Three Rivers PPO $186.38
Rate for Payer: TriWest Veterans Administration $164.01
Rate for Payer: United Healthcare Commercial $216.20
Rate for Payer: United Healthcare Medicare $164.01
Rate for Payer: WINHealth Partners Commercial $236.08
Rate for Payer: Wise Provider Network Commercial $236.08
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $88.71
Max. Negotiated Rate $161.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $157.78
Rate for Payer: Aetna of WY Medicare $106.26
Rate for Payer: Altius Auto/Workers Compensation $154.56
Rate for Payer: Altius Commercial $154.56
Rate for Payer: Beech Street Commercial $157.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $132.18
Rate for Payer: Cash Price $112.70
Rate for Payer: ChoiceCare Network Commercial $156.17
Rate for Payer: Cigna of WY Commercial $157.78
Rate for Payer: Entrust Commercial $152.95
Rate for Payer: First Choice Health Commercial $152.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $93.38
Rate for Payer: HealthUtah PPO $161.00
Rate for Payer: Idaho Integrated Healthcare Commercial $156.17
Rate for Payer: Multiplan Medicare/VA $88.71
Rate for Payer: One Health Plan of WY PPO $157.78
Rate for Payer: PacificSource Commercial $144.90
Rate for Payer: PHCS PPO $157.78
Rate for Payer: Three Rivers PPO $120.75
Rate for Payer: TriWest Veterans Administration $93.38
Rate for Payer: United Healthcare Commercial $140.07
Rate for Payer: United Healthcare Medicare $93.38
Rate for Payer: WINHealth Partners Commercial $157.78
Rate for Payer: Wise Provider Network Commercial $152.95
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $100.95
Max. Negotiated Rate $161.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $157.78
Rate for Payer: Altius Auto/Workers Compensation $154.56
Rate for Payer: Altius Commercial $154.56
Rate for Payer: Beech Street Commercial $157.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $132.18
Rate for Payer: Cash Price $112.70
Rate for Payer: ChoiceCare Network Commercial $156.17
Rate for Payer: Cigna of WY Commercial $157.78
Rate for Payer: Entrust Commercial $152.95
Rate for Payer: First Choice Health Commercial $152.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $152.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $106.26
Rate for Payer: HealthUtah PPO $161.00
Rate for Payer: Idaho Integrated Healthcare Commercial $156.17
Rate for Payer: Multiplan Medicare/VA $100.95
Rate for Payer: One Health Plan of WY PPO $157.78
Rate for Payer: PacificSource Commercial $144.90
Rate for Payer: PHCS PPO $157.78
Rate for Payer: Three Rivers PPO $120.75
Rate for Payer: TriWest Veterans Administration $106.26
Rate for Payer: United Healthcare Commercial $140.07
Rate for Payer: United Healthcare Medicare $106.26
Rate for Payer: WINHealth Partners Commercial $152.95
Rate for Payer: Wise Provider Network Commercial $152.95
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $50.47
Max. Negotiated Rate $80.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $78.89
Rate for Payer: Altius Auto/Workers Compensation $77.28
Rate for Payer: Altius Commercial $77.28
Rate for Payer: Beech Street Commercial $78.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $66.09
Rate for Payer: Cash Price $56.35
Rate for Payer: ChoiceCare Network Commercial $78.08
Rate for Payer: Cigna of WY Commercial $78.89
Rate for Payer: Entrust Commercial $76.48
Rate for Payer: First Choice Health Commercial $76.48
Rate for Payer: Government Employees Health Association (GEHA) Commercial $76.48
Rate for Payer: Government Employees Health Association (GEHA) Medicare $53.13
Rate for Payer: HealthUtah PPO $80.50
Rate for Payer: Idaho Integrated Healthcare Commercial $78.08
Rate for Payer: Multiplan Medicare/VA $50.47
Rate for Payer: One Health Plan of WY PPO $78.89
Rate for Payer: PacificSource Commercial $72.45
Rate for Payer: PHCS PPO $78.89
Rate for Payer: Three Rivers PPO $60.38
Rate for Payer: TriWest Veterans Administration $53.13
Rate for Payer: United Healthcare Commercial $70.04
Rate for Payer: United Healthcare Medicare $53.13
Rate for Payer: WINHealth Partners Commercial $76.48
Rate for Payer: Wise Provider Network Commercial $76.48
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $44.36
Max. Negotiated Rate $80.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $78.89
Rate for Payer: Aetna of WY Medicare $53.13
Rate for Payer: Altius Auto/Workers Compensation $77.28
Rate for Payer: Altius Commercial $77.28
Rate for Payer: Beech Street Commercial $78.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $66.09
Rate for Payer: Cash Price $56.35
Rate for Payer: ChoiceCare Network Commercial $78.08
Rate for Payer: Cigna of WY Commercial $78.89
Rate for Payer: Entrust Commercial $76.48
Rate for Payer: First Choice Health Commercial $76.48
Rate for Payer: Government Employees Health Association (GEHA) Commercial $76.48
Rate for Payer: Government Employees Health Association (GEHA) Medicare $46.69
Rate for Payer: HealthUtah PPO $80.50
Rate for Payer: Idaho Integrated Healthcare Commercial $78.08
Rate for Payer: Multiplan Medicare/VA $44.36
Rate for Payer: One Health Plan of WY PPO $78.89
Rate for Payer: PacificSource Commercial $72.45
Rate for Payer: PHCS PPO $78.89
Rate for Payer: Three Rivers PPO $60.38
Rate for Payer: TriWest Veterans Administration $46.69
Rate for Payer: United Healthcare Commercial $70.04
Rate for Payer: United Healthcare Medicare $46.69
Rate for Payer: WINHealth Partners Commercial $78.89
Rate for Payer: Wise Provider Network Commercial $76.48
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $50.47
Max. Negotiated Rate $80.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $78.89
Rate for Payer: Altius Auto/Workers Compensation $77.28
Rate for Payer: Altius Commercial $77.28
Rate for Payer: Beech Street Commercial $78.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $66.09
Rate for Payer: Cash Price $56.35
Rate for Payer: ChoiceCare Network Commercial $78.08
Rate for Payer: Cigna of WY Commercial $78.89
Rate for Payer: Entrust Commercial $76.48
Rate for Payer: First Choice Health Commercial $76.48
Rate for Payer: Government Employees Health Association (GEHA) Commercial $76.48
Rate for Payer: Government Employees Health Association (GEHA) Medicare $53.13
Rate for Payer: HealthUtah PPO $80.50
Rate for Payer: Idaho Integrated Healthcare Commercial $78.08
Rate for Payer: Multiplan Medicare/VA $50.47
Rate for Payer: One Health Plan of WY PPO $78.89
Rate for Payer: PacificSource Commercial $72.45
Rate for Payer: PHCS PPO $78.89
Rate for Payer: Three Rivers PPO $60.38
Rate for Payer: TriWest Veterans Administration $53.13
Rate for Payer: United Healthcare Commercial $70.04
Rate for Payer: United Healthcare Medicare $53.13
Rate for Payer: WINHealth Partners Commercial $76.48
Rate for Payer: Wise Provider Network Commercial $76.48
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $44.36
Max. Negotiated Rate $80.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $78.89
Rate for Payer: Aetna of WY Medicare $53.13
Rate for Payer: Altius Auto/Workers Compensation $77.28
Rate for Payer: Altius Commercial $77.28
Rate for Payer: Beech Street Commercial $78.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $66.09
Rate for Payer: Cash Price $56.35
Rate for Payer: ChoiceCare Network Commercial $78.08
Rate for Payer: Cigna of WY Commercial $78.89
Rate for Payer: Entrust Commercial $76.48
Rate for Payer: First Choice Health Commercial $76.48
Rate for Payer: Government Employees Health Association (GEHA) Commercial $76.48
Rate for Payer: Government Employees Health Association (GEHA) Medicare $46.69
Rate for Payer: HealthUtah PPO $80.50
Rate for Payer: Idaho Integrated Healthcare Commercial $78.08
Rate for Payer: Multiplan Medicare/VA $44.36
Rate for Payer: One Health Plan of WY PPO $78.89
Rate for Payer: PacificSource Commercial $72.45
Rate for Payer: PHCS PPO $78.89
Rate for Payer: Three Rivers PPO $60.38
Rate for Payer: TriWest Veterans Administration $46.69
Rate for Payer: United Healthcare Commercial $70.04
Rate for Payer: United Healthcare Medicare $46.69
Rate for Payer: WINHealth Partners Commercial $78.89
Rate for Payer: Wise Provider Network Commercial $76.48
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $27.00
Max. Negotiated Rate $49.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $48.02
Rate for Payer: Aetna of WY Medicare $32.34
Rate for Payer: Altius Auto/Workers Compensation $47.04
Rate for Payer: Altius Commercial $47.04
Rate for Payer: Beech Street Commercial $48.02
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $40.23
Rate for Payer: Cash Price $34.30
Rate for Payer: ChoiceCare Network Commercial $47.53
Rate for Payer: Cigna of WY Commercial $48.02
Rate for Payer: Entrust Commercial $46.55
Rate for Payer: First Choice Health Commercial $46.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $46.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $28.42
Rate for Payer: HealthUtah PPO $49.00
Rate for Payer: Idaho Integrated Healthcare Commercial $47.53
Rate for Payer: Multiplan Medicare/VA $27.00
Rate for Payer: One Health Plan of WY PPO $48.02
Rate for Payer: PacificSource Commercial $44.10
Rate for Payer: PHCS PPO $48.02
Rate for Payer: Three Rivers PPO $36.75
Rate for Payer: TriWest Veterans Administration $28.42
Rate for Payer: United Healthcare Commercial $42.63
Rate for Payer: United Healthcare Medicare $28.42
Rate for Payer: WINHealth Partners Commercial $48.02
Rate for Payer: Wise Provider Network Commercial $46.55