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Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $6.52
Max. Negotiated Rate $11.84
Rate for Payer: Aetna of WY Commercial/Medical Rental $11.60
Rate for Payer: Aetna of WY Medicare $7.81
Rate for Payer: Altius Auto/Workers Compensation $11.37
Rate for Payer: Altius Commercial $11.37
Rate for Payer: Beech Street Commercial $11.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $9.72
Rate for Payer: Cash Price $8.29
Rate for Payer: ChoiceCare Network Commercial $11.48
Rate for Payer: Cigna of WY Commercial $11.60
Rate for Payer: Entrust Commercial $11.25
Rate for Payer: First Choice Health Commercial $11.25
Rate for Payer: Government Employees Health Association (GEHA) Commercial $11.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $6.87
Rate for Payer: HealthUtah PPO $11.84
Rate for Payer: Idaho Integrated Healthcare Commercial $11.48
Rate for Payer: Multiplan Medicare/VA $6.52
Rate for Payer: One Health Plan of WY PPO $11.60
Rate for Payer: PacificSource Commercial $10.66
Rate for Payer: PHCS PPO $11.60
Rate for Payer: Three Rivers PPO $8.88
Rate for Payer: TriWest Veterans Administration $6.87
Rate for Payer: United Healthcare Commercial $10.30
Rate for Payer: United Healthcare Medicare $6.87
Rate for Payer: WINHealth Partners Commercial $11.60
Rate for Payer: Wise Provider Network Commercial $11.25
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $11.04
Max. Negotiated Rate $20.04
Rate for Payer: Aetna of WY Commercial/Medical Rental $19.64
Rate for Payer: Aetna of WY Medicare $13.23
Rate for Payer: Altius Auto/Workers Compensation $19.24
Rate for Payer: Altius Commercial $19.24
Rate for Payer: Beech Street Commercial $19.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.45
Rate for Payer: Cash Price $14.03
Rate for Payer: ChoiceCare Network Commercial $19.44
Rate for Payer: Cigna of WY Commercial $19.64
Rate for Payer: Entrust Commercial $19.04
Rate for Payer: First Choice Health Commercial $19.04
Rate for Payer: Government Employees Health Association (GEHA) Commercial $19.04
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.62
Rate for Payer: HealthUtah PPO $20.04
Rate for Payer: Idaho Integrated Healthcare Commercial $19.44
Rate for Payer: Multiplan Medicare/VA $11.04
Rate for Payer: One Health Plan of WY PPO $19.64
Rate for Payer: PacificSource Commercial $18.04
Rate for Payer: PHCS PPO $19.64
Rate for Payer: Three Rivers PPO $15.03
Rate for Payer: TriWest Veterans Administration $11.62
Rate for Payer: United Healthcare Commercial $17.43
Rate for Payer: United Healthcare Medicare $11.62
Rate for Payer: WINHealth Partners Commercial $19.64
Rate for Payer: Wise Provider Network Commercial $19.04
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $12.57
Max. Negotiated Rate $20.04
Rate for Payer: Aetna of WY Commercial/Medical Rental $19.64
Rate for Payer: Altius Auto/Workers Compensation $19.24
Rate for Payer: Altius Commercial $19.24
Rate for Payer: Beech Street Commercial $19.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.45
Rate for Payer: Cash Price $14.03
Rate for Payer: ChoiceCare Network Commercial $19.44
Rate for Payer: Cigna of WY Commercial $19.64
Rate for Payer: Entrust Commercial $19.04
Rate for Payer: First Choice Health Commercial $19.04
Rate for Payer: Government Employees Health Association (GEHA) Commercial $19.04
Rate for Payer: Government Employees Health Association (GEHA) Medicare $13.23
Rate for Payer: HealthUtah PPO $20.04
Rate for Payer: Idaho Integrated Healthcare Commercial $19.44
Rate for Payer: Multiplan Medicare/VA $12.57
Rate for Payer: One Health Plan of WY PPO $19.64
Rate for Payer: PacificSource Commercial $18.04
Rate for Payer: PHCS PPO $19.64
Rate for Payer: Three Rivers PPO $15.03
Rate for Payer: TriWest Veterans Administration $13.23
Rate for Payer: United Healthcare Commercial $17.43
Rate for Payer: United Healthcare Medicare $13.23
Rate for Payer: WINHealth Partners Commercial $19.04
Rate for Payer: Wise Provider Network Commercial $19.04
Hospital Charge Code 27000000S1
Hospital Revenue Code 270
Min. Negotiated Rate $21.47
Max. Negotiated Rate $38.96
Rate for Payer: Aetna of WY Commercial/Medical Rental $38.18
Rate for Payer: Aetna of WY Medicare $25.71
Rate for Payer: Altius Auto/Workers Compensation $37.40
Rate for Payer: Altius Commercial $37.40
Rate for Payer: Beech Street Commercial $38.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $31.99
Rate for Payer: Cash Price $27.27
Rate for Payer: ChoiceCare Network Commercial $37.79
Rate for Payer: Cigna of WY Commercial $38.18
Rate for Payer: Entrust Commercial $37.01
Rate for Payer: First Choice Health Commercial $37.01
Rate for Payer: Government Employees Health Association (GEHA) Commercial $37.01
Rate for Payer: Government Employees Health Association (GEHA) Medicare $22.60
Rate for Payer: HealthUtah PPO $38.96
Rate for Payer: Idaho Integrated Healthcare Commercial $37.79
Rate for Payer: Multiplan Medicare/VA $21.47
Rate for Payer: One Health Plan of WY PPO $38.18
Rate for Payer: PacificSource Commercial $35.06
Rate for Payer: PHCS PPO $38.18
Rate for Payer: Three Rivers PPO $29.22
Rate for Payer: TriWest Veterans Administration $22.60
Rate for Payer: United Healthcare Commercial $33.90
Rate for Payer: United Healthcare Medicare $22.60
Rate for Payer: WINHealth Partners Commercial $38.18
Rate for Payer: Wise Provider Network Commercial $37.01
Hospital Charge Code 27000000S1
Hospital Revenue Code 270
Min. Negotiated Rate $24.43
Max. Negotiated Rate $38.96
Rate for Payer: Aetna of WY Commercial/Medical Rental $38.18
Rate for Payer: Altius Auto/Workers Compensation $37.40
Rate for Payer: Altius Commercial $37.40
Rate for Payer: Beech Street Commercial $38.18
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $31.99
Rate for Payer: Cash Price $27.27
Rate for Payer: ChoiceCare Network Commercial $37.79
Rate for Payer: Cigna of WY Commercial $38.18
Rate for Payer: Entrust Commercial $37.01
Rate for Payer: First Choice Health Commercial $37.01
Rate for Payer: Government Employees Health Association (GEHA) Commercial $37.01
Rate for Payer: Government Employees Health Association (GEHA) Medicare $25.71
Rate for Payer: HealthUtah PPO $38.96
Rate for Payer: Idaho Integrated Healthcare Commercial $37.79
Rate for Payer: Multiplan Medicare/VA $24.43
Rate for Payer: One Health Plan of WY PPO $38.18
Rate for Payer: PacificSource Commercial $35.06
Rate for Payer: PHCS PPO $38.18
Rate for Payer: Three Rivers PPO $29.22
Rate for Payer: TriWest Veterans Administration $25.71
Rate for Payer: United Healthcare Commercial $33.90
Rate for Payer: United Healthcare Medicare $25.71
Rate for Payer: WINHealth Partners Commercial $37.01
Rate for Payer: Wise Provider Network Commercial $37.01
Hospital Charge Code 27000000S1
Hospital Revenue Code 270
Min. Negotiated Rate $23.32
Max. Negotiated Rate $37.19
Rate for Payer: Aetna of WY Commercial/Medical Rental $36.45
Rate for Payer: Altius Auto/Workers Compensation $35.70
Rate for Payer: Altius Commercial $35.70
Rate for Payer: Beech Street Commercial $36.45
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $30.53
Rate for Payer: Cash Price $26.03
Rate for Payer: ChoiceCare Network Commercial $36.07
Rate for Payer: Cigna of WY Commercial $36.45
Rate for Payer: Entrust Commercial $35.33
Rate for Payer: First Choice Health Commercial $35.33
Rate for Payer: Government Employees Health Association (GEHA) Commercial $35.33
Rate for Payer: Government Employees Health Association (GEHA) Medicare $24.55
Rate for Payer: HealthUtah PPO $37.19
Rate for Payer: Idaho Integrated Healthcare Commercial $36.07
Rate for Payer: Multiplan Medicare/VA $23.32
Rate for Payer: One Health Plan of WY PPO $36.45
Rate for Payer: PacificSource Commercial $33.47
Rate for Payer: PHCS PPO $36.45
Rate for Payer: Three Rivers PPO $27.89
Rate for Payer: TriWest Veterans Administration $24.55
Rate for Payer: United Healthcare Commercial $32.36
Rate for Payer: United Healthcare Medicare $24.55
Rate for Payer: WINHealth Partners Commercial $35.33
Rate for Payer: Wise Provider Network Commercial $35.33
Hospital Charge Code 27000000S1
Hospital Revenue Code 270
Min. Negotiated Rate $20.49
Max. Negotiated Rate $37.19
Rate for Payer: Aetna of WY Commercial/Medical Rental $36.45
Rate for Payer: Aetna of WY Medicare $24.55
Rate for Payer: Altius Auto/Workers Compensation $35.70
Rate for Payer: Altius Commercial $35.70
Rate for Payer: Beech Street Commercial $36.45
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $30.53
Rate for Payer: Cash Price $26.03
Rate for Payer: ChoiceCare Network Commercial $36.07
Rate for Payer: Cigna of WY Commercial $36.45
Rate for Payer: Entrust Commercial $35.33
Rate for Payer: First Choice Health Commercial $35.33
Rate for Payer: Government Employees Health Association (GEHA) Commercial $35.33
Rate for Payer: Government Employees Health Association (GEHA) Medicare $21.57
Rate for Payer: HealthUtah PPO $37.19
Rate for Payer: Idaho Integrated Healthcare Commercial $36.07
Rate for Payer: Multiplan Medicare/VA $20.49
Rate for Payer: One Health Plan of WY PPO $36.45
Rate for Payer: PacificSource Commercial $33.47
Rate for Payer: PHCS PPO $36.45
Rate for Payer: Three Rivers PPO $27.89
Rate for Payer: TriWest Veterans Administration $21.57
Rate for Payer: United Healthcare Commercial $32.36
Rate for Payer: United Healthcare Medicare $21.57
Rate for Payer: WINHealth Partners Commercial $36.45
Rate for Payer: Wise Provider Network Commercial $35.33
Service Code HCPCS 57720
Hospital Charge Code 57720
Min. Negotiated Rate $276.63
Max. Negotiated Rate $1,591.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,559.18
Rate for Payer: Aetna of WY Medicare $325.45
Rate for Payer: Beech Street Commercial $1,511.45
Rate for Payer: Cash Price $1,113.70
Rate for Payer: Cash Price $1,113.70
Rate for Payer: ChoiceCare Network Commercial $1,543.27
Rate for Payer: Cigna of WY Commercial $1,559.18
Rate for Payer: First Choice Health Commercial $1,431.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,511.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $325.45
Rate for Payer: HealthUtah PPO $1,591.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,543.27
Rate for Payer: Multiplan Medicare/VA $276.63
Rate for Payer: One Health Plan of WY PPO $1,559.18
Rate for Payer: PacificSource Commercial $1,431.90
Rate for Payer: PHCS PPO $1,511.45
Rate for Payer: Three Rivers PPO $1,193.25
Rate for Payer: TriWest Veterans Administration $325.45
Rate for Payer: United Healthcare Commercial $1,384.17
Rate for Payer: United Healthcare Medicare $325.45
Rate for Payer: WINHealth Partners Commercial $1,352.35
Service Code HCPCS 31600
Hospital Charge Code 31600
Min. Negotiated Rate $244.60
Max. Negotiated Rate $1,426.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,397.48
Rate for Payer: Aetna of WY Medicare $287.76
Rate for Payer: Beech Street Commercial $1,354.70
Rate for Payer: Cash Price $998.20
Rate for Payer: Cash Price $998.20
Rate for Payer: ChoiceCare Network Commercial $1,383.22
Rate for Payer: Cigna of WY Commercial $1,397.48
Rate for Payer: First Choice Health Commercial $1,283.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,354.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $287.76
Rate for Payer: HealthUtah PPO $1,426.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,383.22
Rate for Payer: Multiplan Medicare/VA $244.60
Rate for Payer: One Health Plan of WY PPO $1,397.48
Rate for Payer: PacificSource Commercial $1,283.40
Rate for Payer: PHCS PPO $1,354.70
Rate for Payer: Three Rivers PPO $1,069.50
Rate for Payer: TriWest Veterans Administration $287.76
Rate for Payer: United Healthcare Commercial $1,240.62
Rate for Payer: United Healthcare Medicare $287.76
Rate for Payer: WINHealth Partners Commercial $1,212.10
Service Code NDC 6068779511
Hospital Revenue Code 250
Min. Negotiated Rate $0.36
Max. Negotiated Rate $0.58
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.57
Rate for Payer: Altius Auto/Workers Compensation $0.56
Rate for Payer: Altius Commercial $0.56
Rate for Payer: Beech Street Commercial $0.57
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.48
Rate for Payer: Cash Price $0.41
Rate for Payer: ChoiceCare Network Commercial $0.56
Rate for Payer: Cigna of WY Commercial $0.57
Rate for Payer: Entrust Commercial $0.55
Rate for Payer: First Choice Health Commercial $0.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.38
Rate for Payer: HealthUtah PPO $0.58
Rate for Payer: Idaho Integrated Healthcare Commercial $0.56
Rate for Payer: Multiplan Medicare/VA $0.36
Rate for Payer: One Health Plan of WY PPO $0.57
Rate for Payer: PacificSource Commercial $0.52
Rate for Payer: PHCS PPO $0.57
Rate for Payer: Three Rivers PPO $0.44
Rate for Payer: TriWest Veterans Administration $0.38
Rate for Payer: United Healthcare Commercial $0.50
Rate for Payer: United Healthcare Medicare $0.38
Rate for Payer: WINHealth Partners Commercial $0.55
Rate for Payer: Wise Provider Network Commercial $0.55
Service Code NDC 6068779511
Hospital Revenue Code 250
Min. Negotiated Rate $0.32
Max. Negotiated Rate $0.58
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.57
Rate for Payer: Aetna of WY Medicare $0.38
Rate for Payer: Altius Auto/Workers Compensation $0.56
Rate for Payer: Altius Commercial $0.56
Rate for Payer: Beech Street Commercial $0.57
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.48
Rate for Payer: Cash Price $0.41
Rate for Payer: ChoiceCare Network Commercial $0.56
Rate for Payer: Cigna of WY Commercial $0.57
Rate for Payer: Entrust Commercial $0.55
Rate for Payer: First Choice Health Commercial $0.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.34
Rate for Payer: HealthUtah PPO $0.58
Rate for Payer: Idaho Integrated Healthcare Commercial $0.56
Rate for Payer: Multiplan Medicare/VA $0.32
Rate for Payer: One Health Plan of WY PPO $0.57
Rate for Payer: PacificSource Commercial $0.52
Rate for Payer: PHCS PPO $0.57
Rate for Payer: Three Rivers PPO $0.44
Rate for Payer: TriWest Veterans Administration $0.34
Rate for Payer: United Healthcare Commercial $0.50
Rate for Payer: United Healthcare Medicare $0.34
Rate for Payer: WINHealth Partners Commercial $0.57
Rate for Payer: Wise Provider Network Commercial $0.55
Service Code NDC 6808480811
Hospital Revenue Code 250
Min. Negotiated Rate $0.33
Max. Negotiated Rate $0.52
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.51
Rate for Payer: Altius Auto/Workers Compensation $0.50
Rate for Payer: Altius Commercial $0.50
Rate for Payer: Beech Street Commercial $0.51
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.43
Rate for Payer: Cash Price $0.36
Rate for Payer: ChoiceCare Network Commercial $0.50
Rate for Payer: Cigna of WY Commercial $0.51
Rate for Payer: Entrust Commercial $0.49
Rate for Payer: First Choice Health Commercial $0.49
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.49
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.34
Rate for Payer: HealthUtah PPO $0.52
Rate for Payer: Idaho Integrated Healthcare Commercial $0.50
Rate for Payer: Multiplan Medicare/VA $0.33
Rate for Payer: One Health Plan of WY PPO $0.51
Rate for Payer: PacificSource Commercial $0.47
Rate for Payer: PHCS PPO $0.51
Rate for Payer: Three Rivers PPO $0.39
Rate for Payer: TriWest Veterans Administration $0.34
Rate for Payer: United Healthcare Commercial $0.45
Rate for Payer: United Healthcare Medicare $0.34
Rate for Payer: WINHealth Partners Commercial $0.49
Rate for Payer: Wise Provider Network Commercial $0.49
Service Code NDC 6808480811
Hospital Revenue Code 250
Min. Negotiated Rate $0.29
Max. Negotiated Rate $0.52
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.51
Rate for Payer: Aetna of WY Medicare $0.34
Rate for Payer: Altius Auto/Workers Compensation $0.50
Rate for Payer: Altius Commercial $0.50
Rate for Payer: Beech Street Commercial $0.51
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.43
Rate for Payer: Cash Price $0.36
Rate for Payer: ChoiceCare Network Commercial $0.50
Rate for Payer: Cigna of WY Commercial $0.51
Rate for Payer: Entrust Commercial $0.49
Rate for Payer: First Choice Health Commercial $0.49
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.49
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.30
Rate for Payer: HealthUtah PPO $0.52
Rate for Payer: Idaho Integrated Healthcare Commercial $0.50
Rate for Payer: Multiplan Medicare/VA $0.29
Rate for Payer: One Health Plan of WY PPO $0.51
Rate for Payer: PacificSource Commercial $0.47
Rate for Payer: PHCS PPO $0.51
Rate for Payer: Three Rivers PPO $0.39
Rate for Payer: TriWest Veterans Administration $0.30
Rate for Payer: United Healthcare Commercial $0.45
Rate for Payer: United Healthcare Medicare $0.30
Rate for Payer: WINHealth Partners Commercial $0.51
Rate for Payer: Wise Provider Network Commercial $0.49
Service Code NDC 2315516631
Hospital Revenue Code 250
Min. Negotiated Rate $10.43
Max. Negotiated Rate $16.64
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.31
Rate for Payer: Altius Auto/Workers Compensation $15.97
Rate for Payer: Altius Commercial $15.97
Rate for Payer: Beech Street Commercial $16.31
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $13.66
Rate for Payer: Cash Price $11.65
Rate for Payer: ChoiceCare Network Commercial $16.14
Rate for Payer: Cigna of WY Commercial $16.31
Rate for Payer: Entrust Commercial $15.81
Rate for Payer: First Choice Health Commercial $15.81
Rate for Payer: Government Employees Health Association (GEHA) Commercial $15.81
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.98
Rate for Payer: HealthUtah PPO $16.64
Rate for Payer: Idaho Integrated Healthcare Commercial $16.14
Rate for Payer: Multiplan Medicare/VA $10.43
Rate for Payer: One Health Plan of WY PPO $16.31
Rate for Payer: PacificSource Commercial $14.98
Rate for Payer: PHCS PPO $16.31
Rate for Payer: Three Rivers PPO $12.48
Rate for Payer: TriWest Veterans Administration $10.98
Rate for Payer: United Healthcare Commercial $14.48
Rate for Payer: United Healthcare Medicare $10.98
Rate for Payer: WINHealth Partners Commercial $15.81
Rate for Payer: Wise Provider Network Commercial $15.81
Service Code NDC 2315516631
Hospital Revenue Code 250
Min. Negotiated Rate $9.17
Max. Negotiated Rate $16.64
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.31
Rate for Payer: Aetna of WY Medicare $10.98
Rate for Payer: Altius Auto/Workers Compensation $15.97
Rate for Payer: Altius Commercial $15.97
Rate for Payer: Beech Street Commercial $16.31
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $13.66
Rate for Payer: Cash Price $11.65
Rate for Payer: ChoiceCare Network Commercial $16.14
Rate for Payer: Cigna of WY Commercial $16.31
Rate for Payer: Entrust Commercial $15.81
Rate for Payer: First Choice Health Commercial $15.81
Rate for Payer: Government Employees Health Association (GEHA) Commercial $15.81
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.65
Rate for Payer: HealthUtah PPO $16.64
Rate for Payer: Idaho Integrated Healthcare Commercial $16.14
Rate for Payer: Multiplan Medicare/VA $9.17
Rate for Payer: One Health Plan of WY PPO $16.31
Rate for Payer: PacificSource Commercial $14.98
Rate for Payer: PHCS PPO $16.31
Rate for Payer: Three Rivers PPO $12.48
Rate for Payer: TriWest Veterans Administration $9.65
Rate for Payer: United Healthcare Commercial $14.48
Rate for Payer: United Healthcare Medicare $9.65
Rate for Payer: WINHealth Partners Commercial $16.31
Rate for Payer: Wise Provider Network Commercial $15.81
Service Code NDC 4306600801
Hospital Revenue Code 250
Min. Negotiated Rate $10.51
Max. Negotiated Rate $16.76
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.42
Rate for Payer: Altius Auto/Workers Compensation $16.09
Rate for Payer: Altius Commercial $16.09
Rate for Payer: Beech Street Commercial $16.42
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $13.76
Rate for Payer: Cash Price $11.73
Rate for Payer: ChoiceCare Network Commercial $16.26
Rate for Payer: Cigna of WY Commercial $16.42
Rate for Payer: Entrust Commercial $15.92
Rate for Payer: First Choice Health Commercial $15.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $15.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.06
Rate for Payer: HealthUtah PPO $16.76
Rate for Payer: Idaho Integrated Healthcare Commercial $16.26
Rate for Payer: Multiplan Medicare/VA $10.51
Rate for Payer: One Health Plan of WY PPO $16.42
Rate for Payer: PacificSource Commercial $15.08
Rate for Payer: PHCS PPO $16.42
Rate for Payer: Three Rivers PPO $12.57
Rate for Payer: TriWest Veterans Administration $11.06
Rate for Payer: United Healthcare Commercial $14.58
Rate for Payer: United Healthcare Medicare $11.06
Rate for Payer: WINHealth Partners Commercial $15.92
Rate for Payer: Wise Provider Network Commercial $15.92
Service Code NDC 4306600801
Hospital Revenue Code 250
Min. Negotiated Rate $9.23
Max. Negotiated Rate $16.76
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.42
Rate for Payer: Aetna of WY Medicare $11.06
Rate for Payer: Altius Auto/Workers Compensation $16.09
Rate for Payer: Altius Commercial $16.09
Rate for Payer: Beech Street Commercial $16.42
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $13.76
Rate for Payer: Cash Price $11.73
Rate for Payer: ChoiceCare Network Commercial $16.26
Rate for Payer: Cigna of WY Commercial $16.42
Rate for Payer: Entrust Commercial $15.92
Rate for Payer: First Choice Health Commercial $15.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $15.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.72
Rate for Payer: HealthUtah PPO $16.76
Rate for Payer: Idaho Integrated Healthcare Commercial $16.26
Rate for Payer: Multiplan Medicare/VA $9.23
Rate for Payer: One Health Plan of WY PPO $16.42
Rate for Payer: PacificSource Commercial $15.08
Rate for Payer: PHCS PPO $16.42
Rate for Payer: Three Rivers PPO $12.57
Rate for Payer: TriWest Veterans Administration $9.72
Rate for Payer: United Healthcare Commercial $14.58
Rate for Payer: United Healthcare Medicare $9.72
Rate for Payer: WINHealth Partners Commercial $16.42
Rate for Payer: Wise Provider Network Commercial $15.92
Service Code NDC 4306600810
Hospital Revenue Code 250
Min. Negotiated Rate $10.51
Max. Negotiated Rate $16.76
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.42
Rate for Payer: Altius Auto/Workers Compensation $16.09
Rate for Payer: Altius Commercial $16.09
Rate for Payer: Beech Street Commercial $16.42
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $13.76
Rate for Payer: Cash Price $11.73
Rate for Payer: ChoiceCare Network Commercial $16.26
Rate for Payer: Cigna of WY Commercial $16.42
Rate for Payer: Entrust Commercial $15.92
Rate for Payer: First Choice Health Commercial $15.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $15.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.06
Rate for Payer: HealthUtah PPO $16.76
Rate for Payer: Idaho Integrated Healthcare Commercial $16.26
Rate for Payer: Multiplan Medicare/VA $10.51
Rate for Payer: One Health Plan of WY PPO $16.42
Rate for Payer: PacificSource Commercial $15.08
Rate for Payer: PHCS PPO $16.42
Rate for Payer: Three Rivers PPO $12.57
Rate for Payer: TriWest Veterans Administration $11.06
Rate for Payer: United Healthcare Commercial $14.58
Rate for Payer: United Healthcare Medicare $11.06
Rate for Payer: WINHealth Partners Commercial $15.92
Rate for Payer: Wise Provider Network Commercial $15.92
Service Code NDC 4306600810
Hospital Revenue Code 250
Min. Negotiated Rate $9.23
Max. Negotiated Rate $16.76
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.42
Rate for Payer: Aetna of WY Medicare $11.06
Rate for Payer: Altius Auto/Workers Compensation $16.09
Rate for Payer: Altius Commercial $16.09
Rate for Payer: Beech Street Commercial $16.42
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $13.76
Rate for Payer: Cash Price $11.73
Rate for Payer: ChoiceCare Network Commercial $16.26
Rate for Payer: Cigna of WY Commercial $16.42
Rate for Payer: Entrust Commercial $15.92
Rate for Payer: First Choice Health Commercial $15.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $15.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.72
Rate for Payer: HealthUtah PPO $16.76
Rate for Payer: Idaho Integrated Healthcare Commercial $16.26
Rate for Payer: Multiplan Medicare/VA $9.23
Rate for Payer: One Health Plan of WY PPO $16.42
Rate for Payer: PacificSource Commercial $15.08
Rate for Payer: PHCS PPO $16.42
Rate for Payer: Three Rivers PPO $12.57
Rate for Payer: TriWest Veterans Administration $9.72
Rate for Payer: United Healthcare Commercial $14.58
Rate for Payer: United Healthcare Medicare $9.72
Rate for Payer: WINHealth Partners Commercial $16.42
Rate for Payer: Wise Provider Network Commercial $15.92
Service Code NDC 5515018810
Hospital Revenue Code 250
Min. Negotiated Rate $10.91
Max. Negotiated Rate $17.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $17.05
Rate for Payer: Altius Auto/Workers Compensation $16.70
Rate for Payer: Altius Commercial $16.70
Rate for Payer: Beech Street Commercial $17.05
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.29
Rate for Payer: Cash Price $12.18
Rate for Payer: ChoiceCare Network Commercial $16.88
Rate for Payer: Cigna of WY Commercial $17.05
Rate for Payer: Entrust Commercial $16.53
Rate for Payer: First Choice Health Commercial $16.53
Rate for Payer: Government Employees Health Association (GEHA) Commercial $16.53
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.48
Rate for Payer: HealthUtah PPO $17.40
Rate for Payer: Idaho Integrated Healthcare Commercial $16.88
Rate for Payer: Multiplan Medicare/VA $10.91
Rate for Payer: One Health Plan of WY PPO $17.05
Rate for Payer: PacificSource Commercial $15.66
Rate for Payer: PHCS PPO $17.05
Rate for Payer: Three Rivers PPO $13.05
Rate for Payer: TriWest Veterans Administration $11.48
Rate for Payer: United Healthcare Commercial $15.14
Rate for Payer: United Healthcare Medicare $11.48
Rate for Payer: WINHealth Partners Commercial $16.53
Rate for Payer: Wise Provider Network Commercial $16.53
Service Code NDC 5515018810
Hospital Revenue Code 250
Min. Negotiated Rate $9.59
Max. Negotiated Rate $17.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $17.05
Rate for Payer: Aetna of WY Medicare $11.48
Rate for Payer: Altius Auto/Workers Compensation $16.70
Rate for Payer: Altius Commercial $16.70
Rate for Payer: Beech Street Commercial $17.05
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.29
Rate for Payer: Cash Price $12.18
Rate for Payer: ChoiceCare Network Commercial $16.88
Rate for Payer: Cigna of WY Commercial $17.05
Rate for Payer: Entrust Commercial $16.53
Rate for Payer: First Choice Health Commercial $16.53
Rate for Payer: Government Employees Health Association (GEHA) Commercial $16.53
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.09
Rate for Payer: HealthUtah PPO $17.40
Rate for Payer: Idaho Integrated Healthcare Commercial $16.88
Rate for Payer: Multiplan Medicare/VA $9.59
Rate for Payer: One Health Plan of WY PPO $17.05
Rate for Payer: PacificSource Commercial $15.66
Rate for Payer: PHCS PPO $17.05
Rate for Payer: Three Rivers PPO $13.05
Rate for Payer: TriWest Veterans Administration $10.09
Rate for Payer: United Healthcare Commercial $15.14
Rate for Payer: United Healthcare Medicare $10.09
Rate for Payer: WINHealth Partners Commercial $17.05
Rate for Payer: Wise Provider Network Commercial $16.53
Service Code NDC 6199006110
Hospital Revenue Code 250
Min. Negotiated Rate $11.41
Max. Negotiated Rate $18.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $17.84
Rate for Payer: Altius Auto/Workers Compensation $17.47
Rate for Payer: Altius Commercial $17.47
Rate for Payer: Beech Street Commercial $17.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.94
Rate for Payer: Cash Price $12.74
Rate for Payer: ChoiceCare Network Commercial $17.65
Rate for Payer: Cigna of WY Commercial $17.84
Rate for Payer: Entrust Commercial $17.29
Rate for Payer: First Choice Health Commercial $17.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $17.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $12.01
Rate for Payer: HealthUtah PPO $18.20
Rate for Payer: Idaho Integrated Healthcare Commercial $17.65
Rate for Payer: Multiplan Medicare/VA $11.41
Rate for Payer: One Health Plan of WY PPO $17.84
Rate for Payer: PacificSource Commercial $16.38
Rate for Payer: PHCS PPO $17.84
Rate for Payer: Three Rivers PPO $13.65
Rate for Payer: TriWest Veterans Administration $12.01
Rate for Payer: United Healthcare Commercial $15.83
Rate for Payer: United Healthcare Medicare $12.01
Rate for Payer: WINHealth Partners Commercial $17.29
Rate for Payer: Wise Provider Network Commercial $17.29
Service Code NDC 6199006110
Hospital Revenue Code 250
Min. Negotiated Rate $10.03
Max. Negotiated Rate $18.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $17.84
Rate for Payer: Aetna of WY Medicare $12.01
Rate for Payer: Altius Auto/Workers Compensation $17.47
Rate for Payer: Altius Commercial $17.47
Rate for Payer: Beech Street Commercial $17.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.94
Rate for Payer: Cash Price $12.74
Rate for Payer: ChoiceCare Network Commercial $17.65
Rate for Payer: Cigna of WY Commercial $17.84
Rate for Payer: Entrust Commercial $17.29
Rate for Payer: First Choice Health Commercial $17.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $17.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.56
Rate for Payer: HealthUtah PPO $18.20
Rate for Payer: Idaho Integrated Healthcare Commercial $17.65
Rate for Payer: Multiplan Medicare/VA $10.03
Rate for Payer: One Health Plan of WY PPO $17.84
Rate for Payer: PacificSource Commercial $16.38
Rate for Payer: PHCS PPO $17.84
Rate for Payer: Three Rivers PPO $13.65
Rate for Payer: TriWest Veterans Administration $10.56
Rate for Payer: United Healthcare Commercial $15.83
Rate for Payer: United Healthcare Medicare $10.56
Rate for Payer: WINHealth Partners Commercial $17.84
Rate for Payer: Wise Provider Network Commercial $17.29
Service Code NDC 8128461100
Hospital Revenue Code 250
Min. Negotiated Rate $10.78
Max. Negotiated Rate $17.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.86
Rate for Payer: Altius Auto/Workers Compensation $16.51
Rate for Payer: Altius Commercial $16.51
Rate for Payer: Beech Street Commercial $16.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.12
Rate for Payer: Cash Price $12.04
Rate for Payer: ChoiceCare Network Commercial $16.68
Rate for Payer: Cigna of WY Commercial $16.86
Rate for Payer: Entrust Commercial $16.34
Rate for Payer: First Choice Health Commercial $16.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $16.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.35
Rate for Payer: HealthUtah PPO $17.20
Rate for Payer: Idaho Integrated Healthcare Commercial $16.68
Rate for Payer: Multiplan Medicare/VA $10.78
Rate for Payer: One Health Plan of WY PPO $16.86
Rate for Payer: PacificSource Commercial $15.48
Rate for Payer: PHCS PPO $16.86
Rate for Payer: Three Rivers PPO $12.90
Rate for Payer: TriWest Veterans Administration $11.35
Rate for Payer: United Healthcare Commercial $14.96
Rate for Payer: United Healthcare Medicare $11.35
Rate for Payer: WINHealth Partners Commercial $16.34
Rate for Payer: Wise Provider Network Commercial $16.34
Service Code NDC 8128461100
Hospital Revenue Code 250
Min. Negotiated Rate $9.48
Max. Negotiated Rate $17.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.86
Rate for Payer: Aetna of WY Medicare $11.35
Rate for Payer: Altius Auto/Workers Compensation $16.51
Rate for Payer: Altius Commercial $16.51
Rate for Payer: Beech Street Commercial $16.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.12
Rate for Payer: Cash Price $12.04
Rate for Payer: ChoiceCare Network Commercial $16.68
Rate for Payer: Cigna of WY Commercial $16.86
Rate for Payer: Entrust Commercial $16.34
Rate for Payer: First Choice Health Commercial $16.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $16.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.98
Rate for Payer: HealthUtah PPO $17.20
Rate for Payer: Idaho Integrated Healthcare Commercial $16.68
Rate for Payer: Multiplan Medicare/VA $9.48
Rate for Payer: One Health Plan of WY PPO $16.86
Rate for Payer: PacificSource Commercial $15.48
Rate for Payer: PHCS PPO $16.86
Rate for Payer: Three Rivers PPO $12.90
Rate for Payer: TriWest Veterans Administration $9.98
Rate for Payer: United Healthcare Commercial $14.96
Rate for Payer: United Healthcare Medicare $9.98
Rate for Payer: WINHealth Partners Commercial $16.86
Rate for Payer: Wise Provider Network Commercial $16.34