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Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $56.90
Max. Negotiated Rate $103.27
Rate for Payer: Aetna of WY Commercial/Medical Rental $101.20
Rate for Payer: Aetna of WY Medicare $68.16
Rate for Payer: Altius Auto/Workers Compensation $99.14
Rate for Payer: Altius Commercial $99.14
Rate for Payer: Beech Street Commercial $101.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $84.78
Rate for Payer: Cash Price $72.29
Rate for Payer: ChoiceCare Network Commercial $100.17
Rate for Payer: Cigna of WY Commercial $101.20
Rate for Payer: Entrust Commercial $98.11
Rate for Payer: First Choice Health Commercial $98.11
Rate for Payer: Government Employees Health Association (GEHA) Commercial $98.11
Rate for Payer: Government Employees Health Association (GEHA) Medicare $59.90
Rate for Payer: HealthUtah PPO $103.27
Rate for Payer: Idaho Integrated Healthcare Commercial $100.17
Rate for Payer: Multiplan Medicare/VA $56.90
Rate for Payer: One Health Plan of WY PPO $101.20
Rate for Payer: PacificSource Commercial $92.94
Rate for Payer: PHCS PPO $101.20
Rate for Payer: Three Rivers PPO $77.45
Rate for Payer: TriWest Veterans Administration $59.90
Rate for Payer: United Healthcare Commercial $89.84
Rate for Payer: United Healthcare Medicare $59.90
Rate for Payer: WINHealth Partners Commercial $101.20
Rate for Payer: Wise Provider Network Commercial $98.11
Service Code HCPCS L0220
Hospital Charge Code L0220
Min. Negotiated Rate $21.00
Max. Negotiated Rate $134.74
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.44
Rate for Payer: Aetna of WY Medicare $134.74
Rate for Payer: Beech Street Commercial $26.60
Rate for Payer: Cash Price $19.60
Rate for Payer: Cash Price $19.60
Rate for Payer: ChoiceCare Network Commercial $27.16
Rate for Payer: Cigna of WY Commercial $27.44
Rate for Payer: First Choice Health Commercial $25.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $134.74
Rate for Payer: HealthUtah PPO $28.00
Rate for Payer: Idaho Integrated Healthcare Commercial $27.16
Rate for Payer: Multiplan Medicare/VA $114.53
Rate for Payer: One Health Plan of WY PPO $27.44
Rate for Payer: PacificSource Commercial $25.20
Rate for Payer: PHCS PPO $26.60
Rate for Payer: Three Rivers PPO $21.00
Rate for Payer: TriWest Veterans Administration $134.74
Rate for Payer: United Healthcare Commercial $24.36
Rate for Payer: United Healthcare Medicare $134.74
Rate for Payer: WINHealth Partners Commercial $26.60
Service Code NDC 0338032201
Hospital Revenue Code 250
Min. Negotiated Rate $94.36
Max. Negotiated Rate $150.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.49
Rate for Payer: Altius Auto/Workers Compensation $144.48
Rate for Payer: Altius Commercial $144.48
Rate for Payer: Beech Street Commercial $147.49
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.56
Rate for Payer: Cash Price $105.35
Rate for Payer: ChoiceCare Network Commercial $145.98
Rate for Payer: Cigna of WY Commercial $147.49
Rate for Payer: Entrust Commercial $142.98
Rate for Payer: First Choice Health Commercial $142.98
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.98
Rate for Payer: Government Employees Health Association (GEHA) Medicare $99.33
Rate for Payer: HealthUtah PPO $150.50
Rate for Payer: Idaho Integrated Healthcare Commercial $145.98
Rate for Payer: Multiplan Medicare/VA $94.36
Rate for Payer: One Health Plan of WY PPO $147.49
Rate for Payer: PacificSource Commercial $135.45
Rate for Payer: PHCS PPO $147.49
Rate for Payer: Three Rivers PPO $112.88
Rate for Payer: TriWest Veterans Administration $99.33
Rate for Payer: United Healthcare Commercial $130.94
Rate for Payer: United Healthcare Medicare $99.33
Rate for Payer: WINHealth Partners Commercial $142.98
Rate for Payer: Wise Provider Network Commercial $142.98
Service Code NDC 0338032201
Hospital Revenue Code 250
Min. Negotiated Rate $82.93
Max. Negotiated Rate $150.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.49
Rate for Payer: Aetna of WY Medicare $99.33
Rate for Payer: Altius Auto/Workers Compensation $144.48
Rate for Payer: Altius Commercial $144.48
Rate for Payer: Beech Street Commercial $147.49
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.56
Rate for Payer: Cash Price $105.35
Rate for Payer: ChoiceCare Network Commercial $145.98
Rate for Payer: Cigna of WY Commercial $147.49
Rate for Payer: Entrust Commercial $142.98
Rate for Payer: First Choice Health Commercial $142.98
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.98
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.29
Rate for Payer: HealthUtah PPO $150.50
Rate for Payer: Idaho Integrated Healthcare Commercial $145.98
Rate for Payer: Multiplan Medicare/VA $82.93
Rate for Payer: One Health Plan of WY PPO $147.49
Rate for Payer: PacificSource Commercial $135.45
Rate for Payer: PHCS PPO $147.49
Rate for Payer: Three Rivers PPO $112.88
Rate for Payer: TriWest Veterans Administration $87.29
Rate for Payer: United Healthcare Commercial $130.94
Rate for Payer: United Healthcare Medicare $87.29
Rate for Payer: WINHealth Partners Commercial $147.49
Rate for Payer: Wise Provider Network Commercial $142.98
Service Code NDC 0338032401
Hospital Revenue Code 250
Min. Negotiated Rate $94.36
Max. Negotiated Rate $150.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.49
Rate for Payer: Altius Auto/Workers Compensation $144.48
Rate for Payer: Altius Commercial $144.48
Rate for Payer: Beech Street Commercial $147.49
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.56
Rate for Payer: Cash Price $105.35
Rate for Payer: ChoiceCare Network Commercial $145.98
Rate for Payer: Cigna of WY Commercial $147.49
Rate for Payer: Entrust Commercial $142.98
Rate for Payer: First Choice Health Commercial $142.98
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.98
Rate for Payer: Government Employees Health Association (GEHA) Medicare $99.33
Rate for Payer: HealthUtah PPO $150.50
Rate for Payer: Idaho Integrated Healthcare Commercial $145.98
Rate for Payer: Multiplan Medicare/VA $94.36
Rate for Payer: One Health Plan of WY PPO $147.49
Rate for Payer: PacificSource Commercial $135.45
Rate for Payer: PHCS PPO $147.49
Rate for Payer: Three Rivers PPO $112.88
Rate for Payer: TriWest Veterans Administration $99.33
Rate for Payer: United Healthcare Commercial $130.94
Rate for Payer: United Healthcare Medicare $99.33
Rate for Payer: WINHealth Partners Commercial $142.98
Rate for Payer: Wise Provider Network Commercial $142.98
Service Code NDC 0338032401
Hospital Revenue Code 250
Min. Negotiated Rate $82.93
Max. Negotiated Rate $150.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $147.49
Rate for Payer: Aetna of WY Medicare $99.33
Rate for Payer: Altius Auto/Workers Compensation $144.48
Rate for Payer: Altius Commercial $144.48
Rate for Payer: Beech Street Commercial $147.49
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $123.56
Rate for Payer: Cash Price $105.35
Rate for Payer: ChoiceCare Network Commercial $145.98
Rate for Payer: Cigna of WY Commercial $147.49
Rate for Payer: Entrust Commercial $142.98
Rate for Payer: First Choice Health Commercial $142.98
Rate for Payer: Government Employees Health Association (GEHA) Commercial $142.98
Rate for Payer: Government Employees Health Association (GEHA) Medicare $87.29
Rate for Payer: HealthUtah PPO $150.50
Rate for Payer: Idaho Integrated Healthcare Commercial $145.98
Rate for Payer: Multiplan Medicare/VA $82.93
Rate for Payer: One Health Plan of WY PPO $147.49
Rate for Payer: PacificSource Commercial $135.45
Rate for Payer: PHCS PPO $147.49
Rate for Payer: Three Rivers PPO $112.88
Rate for Payer: TriWest Veterans Administration $87.29
Rate for Payer: United Healthcare Commercial $130.94
Rate for Payer: United Healthcare Medicare $87.29
Rate for Payer: WINHealth Partners Commercial $147.49
Rate for Payer: Wise Provider Network Commercial $142.98
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $916.04
Max. Negotiated Rate $1,662.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,629.25
Rate for Payer: Aetna of WY Medicare $1,097.25
Rate for Payer: Altius Auto/Workers Compensation $1,596.00
Rate for Payer: Altius Commercial $1,596.00
Rate for Payer: Beech Street Commercial $1,629.25
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,364.91
Rate for Payer: Cash Price $1,163.75
Rate for Payer: ChoiceCare Network Commercial $1,612.62
Rate for Payer: Cigna of WY Commercial $1,629.25
Rate for Payer: Entrust Commercial $1,579.38
Rate for Payer: First Choice Health Commercial $1,579.38
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,579.38
Rate for Payer: Government Employees Health Association (GEHA) Medicare $964.25
Rate for Payer: HealthUtah PPO $1,662.50
Rate for Payer: Idaho Integrated Healthcare Commercial $1,612.62
Rate for Payer: Multiplan Medicare/VA $916.04
Rate for Payer: One Health Plan of WY PPO $1,629.25
Rate for Payer: PacificSource Commercial $1,496.25
Rate for Payer: PHCS PPO $1,629.25
Rate for Payer: Three Rivers PPO $1,246.88
Rate for Payer: TriWest Veterans Administration $964.25
Rate for Payer: United Healthcare Commercial $1,446.38
Rate for Payer: United Healthcare Medicare $964.25
Rate for Payer: WINHealth Partners Commercial $1,629.25
Rate for Payer: Wise Provider Network Commercial $1,579.38
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $1,042.39
Max. Negotiated Rate $1,662.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,629.25
Rate for Payer: Altius Auto/Workers Compensation $1,596.00
Rate for Payer: Altius Commercial $1,596.00
Rate for Payer: Beech Street Commercial $1,629.25
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,364.91
Rate for Payer: Cash Price $1,163.75
Rate for Payer: ChoiceCare Network Commercial $1,612.62
Rate for Payer: Cigna of WY Commercial $1,629.25
Rate for Payer: Entrust Commercial $1,579.38
Rate for Payer: First Choice Health Commercial $1,579.38
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,579.38
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,097.25
Rate for Payer: HealthUtah PPO $1,662.50
Rate for Payer: Idaho Integrated Healthcare Commercial $1,612.62
Rate for Payer: Multiplan Medicare/VA $1,042.39
Rate for Payer: One Health Plan of WY PPO $1,629.25
Rate for Payer: PacificSource Commercial $1,496.25
Rate for Payer: PHCS PPO $1,629.25
Rate for Payer: Three Rivers PPO $1,246.88
Rate for Payer: TriWest Veterans Administration $1,097.25
Rate for Payer: United Healthcare Commercial $1,446.38
Rate for Payer: United Healthcare Medicare $1,097.25
Rate for Payer: WINHealth Partners Commercial $1,579.38
Rate for Payer: Wise Provider Network Commercial $1,579.38
Service Code HCPCS 60260 80
Hospital Charge Code 60260
Min. Negotiated Rate $884.64
Max. Negotiated Rate $5,612.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,499.76
Rate for Payer: Aetna of WY Medicare $1,040.75
Rate for Payer: Beech Street Commercial $5,331.40
Rate for Payer: Cash Price $3,928.40
Rate for Payer: Cash Price $3,928.40
Rate for Payer: ChoiceCare Network Commercial $5,443.64
Rate for Payer: Cigna of WY Commercial $5,499.76
Rate for Payer: First Choice Health Commercial $5,050.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,331.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,040.75
Rate for Payer: HealthUtah PPO $5,612.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,443.64
Rate for Payer: Multiplan Medicare/VA $884.64
Rate for Payer: One Health Plan of WY PPO $5,499.76
Rate for Payer: PacificSource Commercial $5,050.80
Rate for Payer: PHCS PPO $5,331.40
Rate for Payer: Three Rivers PPO $4,209.00
Rate for Payer: TriWest Veterans Administration $1,040.75
Rate for Payer: United Healthcare Commercial $4,882.44
Rate for Payer: United Healthcare Medicare $1,040.75
Rate for Payer: WINHealth Partners Commercial $4,770.20
Service Code HCPCS 60260 AS
Hospital Charge Code 60260
Min. Negotiated Rate $884.64
Max. Negotiated Rate $5,612.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,499.76
Rate for Payer: Aetna of WY Medicare $1,040.75
Rate for Payer: Beech Street Commercial $5,331.40
Rate for Payer: Cash Price $3,928.40
Rate for Payer: Cash Price $3,928.40
Rate for Payer: ChoiceCare Network Commercial $5,443.64
Rate for Payer: Cigna of WY Commercial $5,499.76
Rate for Payer: First Choice Health Commercial $5,050.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,331.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,040.75
Rate for Payer: HealthUtah PPO $5,612.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,443.64
Rate for Payer: Multiplan Medicare/VA $884.64
Rate for Payer: One Health Plan of WY PPO $5,499.76
Rate for Payer: PacificSource Commercial $5,050.80
Rate for Payer: PHCS PPO $5,331.40
Rate for Payer: Three Rivers PPO $4,209.00
Rate for Payer: TriWest Veterans Administration $1,040.75
Rate for Payer: United Healthcare Commercial $4,882.44
Rate for Payer: United Healthcare Medicare $1,040.75
Rate for Payer: WINHealth Partners Commercial $4,770.20
Service Code HCPCS 60271
Hospital Charge Code 60271
Min. Negotiated Rate $856.95
Max. Negotiated Rate $3,539.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,468.22
Rate for Payer: Aetna of WY Medicare $1,008.18
Rate for Payer: Beech Street Commercial $3,362.05
Rate for Payer: Cash Price $2,477.30
Rate for Payer: Cash Price $2,477.30
Rate for Payer: ChoiceCare Network Commercial $3,432.83
Rate for Payer: Cigna of WY Commercial $3,468.22
Rate for Payer: First Choice Health Commercial $3,185.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,362.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,008.18
Rate for Payer: HealthUtah PPO $3,539.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,432.83
Rate for Payer: Multiplan Medicare/VA $856.95
Rate for Payer: One Health Plan of WY PPO $3,468.22
Rate for Payer: PacificSource Commercial $3,185.10
Rate for Payer: PHCS PPO $3,362.05
Rate for Payer: Three Rivers PPO $2,654.25
Rate for Payer: TriWest Veterans Administration $1,008.18
Rate for Payer: United Healthcare Commercial $3,078.93
Rate for Payer: United Healthcare Medicare $1,008.18
Rate for Payer: WINHealth Partners Commercial $3,008.15
Service Code HCPCS 60240 AS
Hospital Charge Code 60240
Min. Negotiated Rate $745.75
Max. Negotiated Rate $4,733.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,638.34
Rate for Payer: Aetna of WY Medicare $877.35
Rate for Payer: Beech Street Commercial $4,496.35
Rate for Payer: Cash Price $3,313.10
Rate for Payer: Cash Price $3,313.10
Rate for Payer: ChoiceCare Network Commercial $4,591.01
Rate for Payer: Cigna of WY Commercial $4,638.34
Rate for Payer: First Choice Health Commercial $4,259.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,496.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $877.35
Rate for Payer: HealthUtah PPO $4,733.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,591.01
Rate for Payer: Multiplan Medicare/VA $745.75
Rate for Payer: One Health Plan of WY PPO $4,638.34
Rate for Payer: PacificSource Commercial $4,259.70
Rate for Payer: PHCS PPO $4,496.35
Rate for Payer: Three Rivers PPO $3,549.75
Rate for Payer: TriWest Veterans Administration $877.35
Rate for Payer: United Healthcare Commercial $4,117.71
Rate for Payer: United Healthcare Medicare $877.35
Rate for Payer: WINHealth Partners Commercial $4,023.05
Service Code HCPCS 60240 80
Hospital Charge Code 60240
Min. Negotiated Rate $745.75
Max. Negotiated Rate $4,733.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,638.34
Rate for Payer: Aetna of WY Medicare $877.35
Rate for Payer: Beech Street Commercial $4,496.35
Rate for Payer: Cash Price $3,313.10
Rate for Payer: Cash Price $3,313.10
Rate for Payer: ChoiceCare Network Commercial $4,591.01
Rate for Payer: Cigna of WY Commercial $4,638.34
Rate for Payer: First Choice Health Commercial $4,259.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,496.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $877.35
Rate for Payer: HealthUtah PPO $4,733.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,591.01
Rate for Payer: Multiplan Medicare/VA $745.75
Rate for Payer: One Health Plan of WY PPO $4,638.34
Rate for Payer: PacificSource Commercial $4,259.70
Rate for Payer: PHCS PPO $4,496.35
Rate for Payer: Three Rivers PPO $3,549.75
Rate for Payer: TriWest Veterans Administration $877.35
Rate for Payer: United Healthcare Commercial $4,117.71
Rate for Payer: United Healthcare Medicare $877.35
Rate for Payer: WINHealth Partners Commercial $4,023.05
Service Code HCPCS 60240
Hospital Charge Code 60240
Min. Negotiated Rate $745.75
Max. Negotiated Rate $4,733.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,638.34
Rate for Payer: Aetna of WY Medicare $877.35
Rate for Payer: Beech Street Commercial $4,496.35
Rate for Payer: Cash Price $3,313.10
Rate for Payer: Cash Price $3,313.10
Rate for Payer: ChoiceCare Network Commercial $4,591.01
Rate for Payer: Cigna of WY Commercial $4,638.34
Rate for Payer: First Choice Health Commercial $4,259.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,496.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $877.35
Rate for Payer: HealthUtah PPO $4,733.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,591.01
Rate for Payer: Multiplan Medicare/VA $745.75
Rate for Payer: One Health Plan of WY PPO $4,638.34
Rate for Payer: PacificSource Commercial $4,259.70
Rate for Payer: PHCS PPO $4,496.35
Rate for Payer: Three Rivers PPO $3,549.75
Rate for Payer: TriWest Veterans Administration $877.35
Rate for Payer: United Healthcare Commercial $4,117.71
Rate for Payer: United Healthcare Medicare $877.35
Rate for Payer: WINHealth Partners Commercial $4,023.05
Service Code NDC 4219232901
Hospital Revenue Code 250
Min. Negotiated Rate $1.52
Max. Negotiated Rate $2.75
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.70
Rate for Payer: Aetna of WY Medicare $1.82
Rate for Payer: Altius Auto/Workers Compensation $2.64
Rate for Payer: Altius Commercial $2.64
Rate for Payer: Beech Street Commercial $2.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.26
Rate for Payer: Cash Price $1.93
Rate for Payer: ChoiceCare Network Commercial $2.67
Rate for Payer: Cigna of WY Commercial $2.70
Rate for Payer: Entrust Commercial $2.61
Rate for Payer: First Choice Health Commercial $2.61
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.61
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.60
Rate for Payer: HealthUtah PPO $2.75
Rate for Payer: Idaho Integrated Healthcare Commercial $2.67
Rate for Payer: Multiplan Medicare/VA $1.52
Rate for Payer: One Health Plan of WY PPO $2.70
Rate for Payer: PacificSource Commercial $2.48
Rate for Payer: PHCS PPO $2.70
Rate for Payer: Three Rivers PPO $2.06
Rate for Payer: TriWest Veterans Administration $1.60
Rate for Payer: United Healthcare Commercial $2.39
Rate for Payer: United Healthcare Medicare $1.60
Rate for Payer: WINHealth Partners Commercial $2.70
Rate for Payer: Wise Provider Network Commercial $2.61
Service Code NDC 4219232901
Hospital Revenue Code 250
Min. Negotiated Rate $1.72
Max. Negotiated Rate $2.75
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.70
Rate for Payer: Altius Auto/Workers Compensation $2.64
Rate for Payer: Altius Commercial $2.64
Rate for Payer: Beech Street Commercial $2.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.26
Rate for Payer: Cash Price $1.93
Rate for Payer: ChoiceCare Network Commercial $2.67
Rate for Payer: Cigna of WY Commercial $2.70
Rate for Payer: Entrust Commercial $2.61
Rate for Payer: First Choice Health Commercial $2.61
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.61
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.82
Rate for Payer: HealthUtah PPO $2.75
Rate for Payer: Idaho Integrated Healthcare Commercial $2.67
Rate for Payer: Multiplan Medicare/VA $1.72
Rate for Payer: One Health Plan of WY PPO $2.70
Rate for Payer: PacificSource Commercial $2.48
Rate for Payer: PHCS PPO $2.70
Rate for Payer: Three Rivers PPO $2.06
Rate for Payer: TriWest Veterans Administration $1.82
Rate for Payer: United Healthcare Commercial $2.39
Rate for Payer: United Healthcare Medicare $1.82
Rate for Payer: WINHealth Partners Commercial $2.61
Rate for Payer: Wise Provider Network Commercial $2.61
Service Code NDC 7583431201
Hospital Revenue Code 250
Min. Negotiated Rate $1.69
Max. Negotiated Rate $2.69
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.64
Rate for Payer: Altius Auto/Workers Compensation $2.58
Rate for Payer: Altius Commercial $2.58
Rate for Payer: Beech Street Commercial $2.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.21
Rate for Payer: Cash Price $1.88
Rate for Payer: ChoiceCare Network Commercial $2.61
Rate for Payer: Cigna of WY Commercial $2.64
Rate for Payer: Entrust Commercial $2.56
Rate for Payer: First Choice Health Commercial $2.56
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.56
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.78
Rate for Payer: HealthUtah PPO $2.69
Rate for Payer: Idaho Integrated Healthcare Commercial $2.61
Rate for Payer: Multiplan Medicare/VA $1.69
Rate for Payer: One Health Plan of WY PPO $2.64
Rate for Payer: PacificSource Commercial $2.42
Rate for Payer: PHCS PPO $2.64
Rate for Payer: Three Rivers PPO $2.02
Rate for Payer: TriWest Veterans Administration $1.78
Rate for Payer: United Healthcare Commercial $2.34
Rate for Payer: United Healthcare Medicare $1.78
Rate for Payer: WINHealth Partners Commercial $2.56
Rate for Payer: Wise Provider Network Commercial $2.56
Service Code NDC 7583431201
Hospital Revenue Code 250
Min. Negotiated Rate $1.48
Max. Negotiated Rate $2.69
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.64
Rate for Payer: Aetna of WY Medicare $1.78
Rate for Payer: Altius Auto/Workers Compensation $2.58
Rate for Payer: Altius Commercial $2.58
Rate for Payer: Beech Street Commercial $2.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.21
Rate for Payer: Cash Price $1.88
Rate for Payer: ChoiceCare Network Commercial $2.61
Rate for Payer: Cigna of WY Commercial $2.64
Rate for Payer: Entrust Commercial $2.56
Rate for Payer: First Choice Health Commercial $2.56
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.56
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.56
Rate for Payer: HealthUtah PPO $2.69
Rate for Payer: Idaho Integrated Healthcare Commercial $2.61
Rate for Payer: Multiplan Medicare/VA $1.48
Rate for Payer: One Health Plan of WY PPO $2.64
Rate for Payer: PacificSource Commercial $2.42
Rate for Payer: PHCS PPO $2.64
Rate for Payer: Three Rivers PPO $2.02
Rate for Payer: TriWest Veterans Administration $1.56
Rate for Payer: United Healthcare Commercial $2.34
Rate for Payer: United Healthcare Medicare $1.56
Rate for Payer: WINHealth Partners Commercial $2.64
Rate for Payer: Wise Provider Network Commercial $2.56
Service Code NDC 4219233001
Hospital Revenue Code 250
Min. Negotiated Rate $1.92
Max. Negotiated Rate $3.06
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.00
Rate for Payer: Altius Auto/Workers Compensation $2.94
Rate for Payer: Altius Commercial $2.94
Rate for Payer: Beech Street Commercial $3.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.51
Rate for Payer: Cash Price $2.14
Rate for Payer: ChoiceCare Network Commercial $2.97
Rate for Payer: Cigna of WY Commercial $3.00
Rate for Payer: Entrust Commercial $2.91
Rate for Payer: First Choice Health Commercial $2.91
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.91
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2.02
Rate for Payer: HealthUtah PPO $3.06
Rate for Payer: Idaho Integrated Healthcare Commercial $2.97
Rate for Payer: Multiplan Medicare/VA $1.92
Rate for Payer: One Health Plan of WY PPO $3.00
Rate for Payer: PacificSource Commercial $2.75
Rate for Payer: PHCS PPO $3.00
Rate for Payer: Three Rivers PPO $2.30
Rate for Payer: TriWest Veterans Administration $2.02
Rate for Payer: United Healthcare Commercial $2.66
Rate for Payer: United Healthcare Medicare $2.02
Rate for Payer: WINHealth Partners Commercial $2.91
Rate for Payer: Wise Provider Network Commercial $2.91
Service Code NDC 4219233001
Hospital Revenue Code 250
Min. Negotiated Rate $1.69
Max. Negotiated Rate $3.06
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.00
Rate for Payer: Aetna of WY Medicare $2.02
Rate for Payer: Altius Auto/Workers Compensation $2.94
Rate for Payer: Altius Commercial $2.94
Rate for Payer: Beech Street Commercial $3.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.51
Rate for Payer: Cash Price $2.14
Rate for Payer: ChoiceCare Network Commercial $2.97
Rate for Payer: Cigna of WY Commercial $3.00
Rate for Payer: Entrust Commercial $2.91
Rate for Payer: First Choice Health Commercial $2.91
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.91
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.77
Rate for Payer: HealthUtah PPO $3.06
Rate for Payer: Idaho Integrated Healthcare Commercial $2.97
Rate for Payer: Multiplan Medicare/VA $1.69
Rate for Payer: One Health Plan of WY PPO $3.00
Rate for Payer: PacificSource Commercial $2.75
Rate for Payer: PHCS PPO $3.00
Rate for Payer: Three Rivers PPO $2.30
Rate for Payer: TriWest Veterans Administration $1.77
Rate for Payer: United Healthcare Commercial $2.66
Rate for Payer: United Healthcare Medicare $1.77
Rate for Payer: WINHealth Partners Commercial $3.00
Rate for Payer: Wise Provider Network Commercial $2.91
Service Code HCPCS J3240
Hospital Revenue Code 636
Min. Negotiated Rate $1,218.90
Max. Negotiated Rate $1,944.02
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,905.14
Rate for Payer: Altius Auto/Workers Compensation $1,866.26
Rate for Payer: Altius Commercial $1,866.26
Rate for Payer: Beech Street Commercial $1,905.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,596.04
Rate for Payer: Cash Price $1,360.81
Rate for Payer: ChoiceCare Network Commercial $1,885.70
Rate for Payer: Cigna of WY Commercial $1,905.14
Rate for Payer: Entrust Commercial $1,846.82
Rate for Payer: First Choice Health Commercial $1,846.82
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,846.82
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,283.05
Rate for Payer: HealthUtah PPO $1,944.02
Rate for Payer: Idaho Integrated Healthcare Commercial $1,885.70
Rate for Payer: Multiplan Medicare/VA $1,218.90
Rate for Payer: One Health Plan of WY PPO $1,905.14
Rate for Payer: PacificSource Commercial $1,749.62
Rate for Payer: PHCS PPO $1,905.14
Rate for Payer: Three Rivers PPO $1,458.02
Rate for Payer: TriWest Veterans Administration $1,283.05
Rate for Payer: United Healthcare Commercial $1,691.30
Rate for Payer: United Healthcare Medicare $1,283.05
Rate for Payer: WINHealth Partners Commercial $1,846.82
Rate for Payer: Wise Provider Network Commercial $1,846.82
Service Code HCPCS J3240
Hospital Revenue Code 636
Min. Negotiated Rate $1,071.16
Max. Negotiated Rate $1,944.02
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,905.14
Rate for Payer: Aetna of WY Medicare $1,283.05
Rate for Payer: Altius Auto/Workers Compensation $1,866.26
Rate for Payer: Altius Commercial $1,866.26
Rate for Payer: Beech Street Commercial $1,905.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1,596.04
Rate for Payer: Cash Price $1,360.81
Rate for Payer: ChoiceCare Network Commercial $1,885.70
Rate for Payer: Cigna of WY Commercial $1,905.14
Rate for Payer: Entrust Commercial $1,846.82
Rate for Payer: First Choice Health Commercial $1,846.82
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,846.82
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,127.53
Rate for Payer: HealthUtah PPO $1,944.02
Rate for Payer: Idaho Integrated Healthcare Commercial $1,885.70
Rate for Payer: Multiplan Medicare/VA $1,071.16
Rate for Payer: One Health Plan of WY PPO $1,905.14
Rate for Payer: PacificSource Commercial $1,749.62
Rate for Payer: PHCS PPO $1,905.14
Rate for Payer: Three Rivers PPO $1,458.02
Rate for Payer: TriWest Veterans Administration $1,127.53
Rate for Payer: United Healthcare Commercial $1,691.30
Rate for Payer: United Healthcare Medicare $1,127.53
Rate for Payer: WINHealth Partners Commercial $1,905.14
Rate for Payer: Wise Provider Network Commercial $1,846.82
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $272.12
Max. Negotiated Rate $434.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $425.32
Rate for Payer: Altius Auto/Workers Compensation $416.64
Rate for Payer: Altius Commercial $416.64
Rate for Payer: Beech Street Commercial $425.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $356.31
Rate for Payer: Cash Price $303.80
Rate for Payer: ChoiceCare Network Commercial $420.98
Rate for Payer: Cigna of WY Commercial $425.32
Rate for Payer: Entrust Commercial $412.30
Rate for Payer: First Choice Health Commercial $412.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $412.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $286.44
Rate for Payer: HealthUtah PPO $434.00
Rate for Payer: Idaho Integrated Healthcare Commercial $420.98
Rate for Payer: Multiplan Medicare/VA $272.12
Rate for Payer: One Health Plan of WY PPO $425.32
Rate for Payer: PacificSource Commercial $390.60
Rate for Payer: PHCS PPO $425.32
Rate for Payer: Three Rivers PPO $325.50
Rate for Payer: TriWest Veterans Administration $286.44
Rate for Payer: United Healthcare Commercial $377.58
Rate for Payer: United Healthcare Medicare $286.44
Rate for Payer: WINHealth Partners Commercial $412.30
Rate for Payer: Wise Provider Network Commercial $412.30
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $239.13
Max. Negotiated Rate $434.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $425.32
Rate for Payer: Aetna of WY Medicare $286.44
Rate for Payer: Altius Auto/Workers Compensation $416.64
Rate for Payer: Altius Commercial $416.64
Rate for Payer: Beech Street Commercial $425.32
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $356.31
Rate for Payer: Cash Price $303.80
Rate for Payer: ChoiceCare Network Commercial $420.98
Rate for Payer: Cigna of WY Commercial $425.32
Rate for Payer: Entrust Commercial $412.30
Rate for Payer: First Choice Health Commercial $412.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $412.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $251.72
Rate for Payer: HealthUtah PPO $434.00
Rate for Payer: Idaho Integrated Healthcare Commercial $420.98
Rate for Payer: Multiplan Medicare/VA $239.13
Rate for Payer: One Health Plan of WY PPO $425.32
Rate for Payer: PacificSource Commercial $390.60
Rate for Payer: PHCS PPO $425.32
Rate for Payer: Three Rivers PPO $325.50
Rate for Payer: TriWest Veterans Administration $251.72
Rate for Payer: United Healthcare Commercial $377.58
Rate for Payer: United Healthcare Medicare $251.72
Rate for Payer: WINHealth Partners Commercial $425.32
Rate for Payer: Wise Provider Network Commercial $412.30
Service Code NDC 0186077739
Hospital Revenue Code 250
Min. Negotiated Rate $15.78
Max. Negotiated Rate $25.17
Rate for Payer: Aetna of WY Commercial/Medical Rental $24.67
Rate for Payer: Altius Auto/Workers Compensation $24.16
Rate for Payer: Altius Commercial $24.16
Rate for Payer: Beech Street Commercial $24.67
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $20.66
Rate for Payer: Cash Price $17.62
Rate for Payer: ChoiceCare Network Commercial $24.41
Rate for Payer: Cigna of WY Commercial $24.67
Rate for Payer: Entrust Commercial $23.91
Rate for Payer: First Choice Health Commercial $23.91
Rate for Payer: Government Employees Health Association (GEHA) Commercial $23.91
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.61
Rate for Payer: HealthUtah PPO $25.17
Rate for Payer: Idaho Integrated Healthcare Commercial $24.41
Rate for Payer: Multiplan Medicare/VA $15.78
Rate for Payer: One Health Plan of WY PPO $24.67
Rate for Payer: PacificSource Commercial $22.65
Rate for Payer: PHCS PPO $24.67
Rate for Payer: Three Rivers PPO $18.88
Rate for Payer: TriWest Veterans Administration $16.61
Rate for Payer: United Healthcare Commercial $21.90
Rate for Payer: United Healthcare Medicare $16.61
Rate for Payer: WINHealth Partners Commercial $23.91
Rate for Payer: Wise Provider Network Commercial $23.91