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Service Code HCPCS 76937
Hospital Charge Code 76937
Min. Negotiated Rate $31.71
Max. Negotiated Rate $202.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $197.96
Rate for Payer: Aetna of WY Medicare $37.31
Rate for Payer: Beech Street Commercial $191.90
Rate for Payer: Cash Price $141.40
Rate for Payer: Cash Price $141.40
Rate for Payer: ChoiceCare Network Commercial $195.94
Rate for Payer: Cigna of WY Commercial $197.96
Rate for Payer: First Choice Health Commercial $181.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $191.90
Rate for Payer: Government Employees Health Association (GEHA) Medicare $37.31
Rate for Payer: HealthUtah PPO $202.00
Rate for Payer: Idaho Integrated Healthcare Commercial $195.94
Rate for Payer: Multiplan Medicare/VA $31.71
Rate for Payer: One Health Plan of WY PPO $197.96
Rate for Payer: PacificSource Commercial $181.80
Rate for Payer: PHCS PPO $191.90
Rate for Payer: Three Rivers PPO $151.50
Rate for Payer: TriWest Veterans Administration $37.31
Rate for Payer: United Healthcare Commercial $175.74
Rate for Payer: United Healthcare Medicare $37.31
Rate for Payer: WINHealth Partners Commercial $191.90
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $109.75
Max. Negotiated Rate $175.04
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.54
Rate for Payer: Altius Auto/Workers Compensation $168.04
Rate for Payer: Altius Commercial $168.04
Rate for Payer: Beech Street Commercial $171.54
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.71
Rate for Payer: Cash Price $122.53
Rate for Payer: ChoiceCare Network Commercial $169.79
Rate for Payer: Cigna of WY Commercial $171.54
Rate for Payer: Entrust Commercial $166.29
Rate for Payer: First Choice Health Commercial $166.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $115.53
Rate for Payer: HealthUtah PPO $175.04
Rate for Payer: Idaho Integrated Healthcare Commercial $169.79
Rate for Payer: Multiplan Medicare/VA $109.75
Rate for Payer: One Health Plan of WY PPO $171.54
Rate for Payer: PacificSource Commercial $157.54
Rate for Payer: PHCS PPO $171.54
Rate for Payer: Three Rivers PPO $131.28
Rate for Payer: TriWest Veterans Administration $115.53
Rate for Payer: United Healthcare Commercial $152.28
Rate for Payer: United Healthcare Medicare $115.53
Rate for Payer: WINHealth Partners Commercial $166.29
Rate for Payer: Wise Provider Network Commercial $166.29
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $96.45
Max. Negotiated Rate $175.04
Rate for Payer: Aetna of WY Commercial/Medical Rental $171.54
Rate for Payer: Aetna of WY Medicare $115.53
Rate for Payer: Altius Auto/Workers Compensation $168.04
Rate for Payer: Altius Commercial $168.04
Rate for Payer: Beech Street Commercial $171.54
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $143.71
Rate for Payer: Cash Price $122.53
Rate for Payer: ChoiceCare Network Commercial $169.79
Rate for Payer: Cigna of WY Commercial $171.54
Rate for Payer: Entrust Commercial $166.29
Rate for Payer: First Choice Health Commercial $166.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $166.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $101.52
Rate for Payer: HealthUtah PPO $175.04
Rate for Payer: Idaho Integrated Healthcare Commercial $169.79
Rate for Payer: Multiplan Medicare/VA $96.45
Rate for Payer: One Health Plan of WY PPO $171.54
Rate for Payer: PacificSource Commercial $157.54
Rate for Payer: PHCS PPO $171.54
Rate for Payer: Three Rivers PPO $131.28
Rate for Payer: TriWest Veterans Administration $101.52
Rate for Payer: United Healthcare Commercial $152.28
Rate for Payer: United Healthcare Medicare $101.52
Rate for Payer: WINHealth Partners Commercial $171.54
Rate for Payer: Wise Provider Network Commercial $166.29
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $5.16
Max. Negotiated Rate $8.23
Rate for Payer: Aetna of WY Commercial/Medical Rental $8.07
Rate for Payer: Altius Auto/Workers Compensation $7.90
Rate for Payer: Altius Commercial $7.90
Rate for Payer: Beech Street Commercial $8.07
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6.76
Rate for Payer: Cash Price $5.76
Rate for Payer: ChoiceCare Network Commercial $7.98
Rate for Payer: Cigna of WY Commercial $8.07
Rate for Payer: Entrust Commercial $7.82
Rate for Payer: First Choice Health Commercial $7.82
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7.82
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5.43
Rate for Payer: HealthUtah PPO $8.23
Rate for Payer: Idaho Integrated Healthcare Commercial $7.98
Rate for Payer: Multiplan Medicare/VA $5.16
Rate for Payer: One Health Plan of WY PPO $8.07
Rate for Payer: PacificSource Commercial $7.41
Rate for Payer: PHCS PPO $8.07
Rate for Payer: Three Rivers PPO $6.17
Rate for Payer: TriWest Veterans Administration $5.43
Rate for Payer: United Healthcare Commercial $7.16
Rate for Payer: United Healthcare Medicare $5.43
Rate for Payer: WINHealth Partners Commercial $7.82
Rate for Payer: Wise Provider Network Commercial $7.82
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $4.53
Max. Negotiated Rate $8.23
Rate for Payer: Aetna of WY Commercial/Medical Rental $8.07
Rate for Payer: Aetna of WY Medicare $5.43
Rate for Payer: Altius Auto/Workers Compensation $7.90
Rate for Payer: Altius Commercial $7.90
Rate for Payer: Beech Street Commercial $8.07
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6.76
Rate for Payer: Cash Price $5.76
Rate for Payer: ChoiceCare Network Commercial $7.98
Rate for Payer: Cigna of WY Commercial $8.07
Rate for Payer: Entrust Commercial $7.82
Rate for Payer: First Choice Health Commercial $7.82
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7.82
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4.77
Rate for Payer: HealthUtah PPO $8.23
Rate for Payer: Idaho Integrated Healthcare Commercial $7.98
Rate for Payer: Multiplan Medicare/VA $4.53
Rate for Payer: One Health Plan of WY PPO $8.07
Rate for Payer: PacificSource Commercial $7.41
Rate for Payer: PHCS PPO $8.07
Rate for Payer: Three Rivers PPO $6.17
Rate for Payer: TriWest Veterans Administration $4.77
Rate for Payer: United Healthcare Commercial $7.16
Rate for Payer: United Healthcare Medicare $4.77
Rate for Payer: WINHealth Partners Commercial $8.07
Rate for Payer: Wise Provider Network Commercial $7.82
Service Code HCPCS 58400
Hospital Charge Code 58400
Min. Negotiated Rate $382.36
Max. Negotiated Rate $1,631.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,598.38
Rate for Payer: Aetna of WY Medicare $449.83
Rate for Payer: Beech Street Commercial $1,549.45
Rate for Payer: Cash Price $1,141.70
Rate for Payer: Cash Price $1,141.70
Rate for Payer: ChoiceCare Network Commercial $1,582.07
Rate for Payer: Cigna of WY Commercial $1,598.38
Rate for Payer: First Choice Health Commercial $1,467.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,549.45
Rate for Payer: Government Employees Health Association (GEHA) Medicare $449.83
Rate for Payer: HealthUtah PPO $1,631.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,582.07
Rate for Payer: Multiplan Medicare/VA $382.36
Rate for Payer: One Health Plan of WY PPO $1,598.38
Rate for Payer: PacificSource Commercial $1,467.90
Rate for Payer: PHCS PPO $1,549.45
Rate for Payer: Three Rivers PPO $1,223.25
Rate for Payer: TriWest Veterans Administration $449.83
Rate for Payer: United Healthcare Commercial $1,418.97
Rate for Payer: United Healthcare Medicare $449.83
Rate for Payer: WINHealth Partners Commercial $1,386.35
Service Code HCPCS 42140
Hospital Charge Code 42140
Min. Negotiated Rate $136.03
Max. Negotiated Rate $1,088.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,066.24
Rate for Payer: Aetna of WY Medicare $160.03
Rate for Payer: Beech Street Commercial $1,033.60
Rate for Payer: Cash Price $761.60
Rate for Payer: Cash Price $761.60
Rate for Payer: ChoiceCare Network Commercial $1,055.36
Rate for Payer: Cigna of WY Commercial $1,066.24
Rate for Payer: First Choice Health Commercial $979.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,033.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $160.03
Rate for Payer: HealthUtah PPO $1,088.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,055.36
Rate for Payer: Multiplan Medicare/VA $136.03
Rate for Payer: One Health Plan of WY PPO $1,066.24
Rate for Payer: PacificSource Commercial $979.20
Rate for Payer: PHCS PPO $1,033.60
Rate for Payer: Three Rivers PPO $816.00
Rate for Payer: TriWest Veterans Administration $160.03
Rate for Payer: United Healthcare Commercial $946.56
Rate for Payer: United Healthcare Medicare $160.03
Rate for Payer: WINHealth Partners Commercial $924.80
Service Code HCPCS 58262
Hospital Charge Code 58262
Min. Negotiated Rate $758.95
Max. Negotiated Rate $4,407.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $4,318.86
Rate for Payer: Aetna of WY Medicare $892.88
Rate for Payer: Beech Street Commercial $4,186.65
Rate for Payer: Cash Price $3,084.90
Rate for Payer: Cash Price $3,084.90
Rate for Payer: ChoiceCare Network Commercial $4,274.79
Rate for Payer: Cigna of WY Commercial $4,318.86
Rate for Payer: First Choice Health Commercial $3,966.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4,186.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $892.88
Rate for Payer: HealthUtah PPO $4,407.00
Rate for Payer: Idaho Integrated Healthcare Commercial $4,274.79
Rate for Payer: Multiplan Medicare/VA $758.95
Rate for Payer: One Health Plan of WY PPO $4,318.86
Rate for Payer: PacificSource Commercial $3,966.30
Rate for Payer: PHCS PPO $4,186.65
Rate for Payer: Three Rivers PPO $3,305.25
Rate for Payer: TriWest Veterans Administration $892.88
Rate for Payer: United Healthcare Commercial $3,834.09
Rate for Payer: United Healthcare Medicare $892.88
Rate for Payer: WINHealth Partners Commercial $3,745.95
Service Code HCPCS 59612
Hospital Charge Code 59612
Min. Negotiated Rate $721.58
Max. Negotiated Rate $2,744.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,689.12
Rate for Payer: Aetna of WY Medicare $848.92
Rate for Payer: Beech Street Commercial $2,606.80
Rate for Payer: Cash Price $1,920.80
Rate for Payer: Cash Price $1,920.80
Rate for Payer: ChoiceCare Network Commercial $2,661.68
Rate for Payer: Cigna of WY Commercial $2,689.12
Rate for Payer: First Choice Health Commercial $2,469.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,606.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $848.92
Rate for Payer: HealthUtah PPO $2,744.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,661.68
Rate for Payer: Multiplan Medicare/VA $721.58
Rate for Payer: One Health Plan of WY PPO $2,689.12
Rate for Payer: PacificSource Commercial $2,469.60
Rate for Payer: PHCS PPO $2,606.80
Rate for Payer: Three Rivers PPO $2,058.00
Rate for Payer: TriWest Veterans Administration $848.92
Rate for Payer: United Healthcare Commercial $2,387.28
Rate for Payer: United Healthcare Medicare $848.92
Rate for Payer: WINHealth Partners Commercial $2,332.40
Service Code HCPCS 59409
Hospital Charge Code 59409
Min. Negotiated Rate $639.85
Max. Negotiated Rate $2,383.36
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,383.36
Rate for Payer: Aetna of WY Medicare $752.77
Rate for Payer: Beech Street Commercial $2,310.40
Rate for Payer: Cash Price $1,702.40
Rate for Payer: Cash Price $1,702.40
Rate for Payer: ChoiceCare Network Commercial $2,359.04
Rate for Payer: Cigna of WY Commercial $2,383.36
Rate for Payer: First Choice Health Commercial $2,188.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,310.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $752.77
Rate for Payer: HealthUtah PPO $1,406.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,359.04
Rate for Payer: Multiplan Medicare/VA $639.85
Rate for Payer: One Health Plan of WY PPO $2,383.36
Rate for Payer: PacificSource Commercial $2,188.80
Rate for Payer: PHCS PPO $2,310.40
Rate for Payer: Three Rivers PPO $1,824.00
Rate for Payer: TriWest Veterans Administration $752.77
Rate for Payer: United Healthcare Commercial $2,115.84
Rate for Payer: United Healthcare Medicare $752.77
Rate for Payer: WINHealth Partners Commercial $2,067.20
Service Code HCPCS 59410
Hospital Charge Code 59410
Min. Negotiated Rate $867.42
Max. Negotiated Rate $3,133.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,070.34
Rate for Payer: Aetna of WY Medicare $1,020.50
Rate for Payer: Beech Street Commercial $2,976.35
Rate for Payer: Cash Price $2,193.10
Rate for Payer: Cash Price $2,193.10
Rate for Payer: ChoiceCare Network Commercial $3,039.01
Rate for Payer: Cigna of WY Commercial $3,070.34
Rate for Payer: First Choice Health Commercial $2,819.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,976.35
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,020.50
Rate for Payer: HealthUtah PPO $3,133.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,039.01
Rate for Payer: Multiplan Medicare/VA $867.42
Rate for Payer: One Health Plan of WY PPO $3,070.34
Rate for Payer: PacificSource Commercial $2,819.70
Rate for Payer: PHCS PPO $2,976.35
Rate for Payer: Three Rivers PPO $2,349.75
Rate for Payer: TriWest Veterans Administration $1,020.50
Rate for Payer: United Healthcare Commercial $2,725.71
Rate for Payer: United Healthcare Medicare $1,020.50
Rate for Payer: WINHealth Partners Commercial $2,663.05
Service Code HCPCS 59614
Hospital Charge Code 59614
Min. Negotiated Rate $932.76
Max. Negotiated Rate $3,412.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,343.76
Rate for Payer: Aetna of WY Medicare $1,097.37
Rate for Payer: Beech Street Commercial $3,241.40
Rate for Payer: Cash Price $2,388.40
Rate for Payer: Cash Price $2,388.40
Rate for Payer: ChoiceCare Network Commercial $3,309.64
Rate for Payer: Cigna of WY Commercial $3,343.76
Rate for Payer: First Choice Health Commercial $3,070.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,241.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,097.37
Rate for Payer: HealthUtah PPO $3,412.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,309.64
Rate for Payer: Multiplan Medicare/VA $932.76
Rate for Payer: One Health Plan of WY PPO $3,343.76
Rate for Payer: PacificSource Commercial $3,070.80
Rate for Payer: PHCS PPO $3,241.40
Rate for Payer: Three Rivers PPO $2,559.00
Rate for Payer: TriWest Veterans Administration $1,097.37
Rate for Payer: United Healthcare Commercial $2,968.44
Rate for Payer: United Healthcare Medicare $1,097.37
Rate for Payer: WINHealth Partners Commercial $2,900.20
Service Code HCPCS 58260
Hospital Charge Code 58260
Min. Negotiated Rate $687.22
Max. Negotiated Rate $4,035.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,954.30
Rate for Payer: Aetna of WY Medicare $808.50
Rate for Payer: Beech Street Commercial $3,833.25
Rate for Payer: Cash Price $2,824.50
Rate for Payer: Cash Price $2,824.50
Rate for Payer: ChoiceCare Network Commercial $3,913.95
Rate for Payer: Cigna of WY Commercial $3,954.30
Rate for Payer: First Choice Health Commercial $3,631.50
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3,833.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $808.50
Rate for Payer: HealthUtah PPO $4,035.00
Rate for Payer: Idaho Integrated Healthcare Commercial $3,913.95
Rate for Payer: Multiplan Medicare/VA $687.22
Rate for Payer: One Health Plan of WY PPO $3,954.30
Rate for Payer: PacificSource Commercial $3,631.50
Rate for Payer: PHCS PPO $3,833.25
Rate for Payer: Three Rivers PPO $3,026.25
Rate for Payer: TriWest Veterans Administration $808.50
Rate for Payer: United Healthcare Commercial $3,510.45
Rate for Payer: United Healthcare Medicare $808.50
Rate for Payer: WINHealth Partners Commercial $3,429.75
Service Code NDC 6808430911
Hospital Revenue Code 250
Min. Negotiated Rate $7.23
Max. Negotiated Rate $13.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $12.86
Rate for Payer: Aetna of WY Medicare $8.66
Rate for Payer: Altius Auto/Workers Compensation $12.60
Rate for Payer: Altius Commercial $12.60
Rate for Payer: Beech Street Commercial $12.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $10.77
Rate for Payer: Cash Price $9.19
Rate for Payer: ChoiceCare Network Commercial $12.73
Rate for Payer: Cigna of WY Commercial $12.86
Rate for Payer: Entrust Commercial $12.46
Rate for Payer: First Choice Health Commercial $12.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $12.46
Rate for Payer: Government Employees Health Association (GEHA) Medicare $7.61
Rate for Payer: HealthUtah PPO $13.12
Rate for Payer: Idaho Integrated Healthcare Commercial $12.73
Rate for Payer: Multiplan Medicare/VA $7.23
Rate for Payer: One Health Plan of WY PPO $12.86
Rate for Payer: PacificSource Commercial $11.81
Rate for Payer: PHCS PPO $12.86
Rate for Payer: Three Rivers PPO $9.84
Rate for Payer: TriWest Veterans Administration $7.61
Rate for Payer: United Healthcare Commercial $11.41
Rate for Payer: United Healthcare Medicare $7.61
Rate for Payer: WINHealth Partners Commercial $12.86
Rate for Payer: Wise Provider Network Commercial $12.46
Service Code NDC 6808430911
Hospital Revenue Code 250
Min. Negotiated Rate $8.23
Max. Negotiated Rate $13.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $12.86
Rate for Payer: Altius Auto/Workers Compensation $12.60
Rate for Payer: Altius Commercial $12.60
Rate for Payer: Beech Street Commercial $12.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $10.77
Rate for Payer: Cash Price $9.19
Rate for Payer: ChoiceCare Network Commercial $12.73
Rate for Payer: Cigna of WY Commercial $12.86
Rate for Payer: Entrust Commercial $12.46
Rate for Payer: First Choice Health Commercial $12.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $12.46
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.66
Rate for Payer: HealthUtah PPO $13.12
Rate for Payer: Idaho Integrated Healthcare Commercial $12.73
Rate for Payer: Multiplan Medicare/VA $8.23
Rate for Payer: One Health Plan of WY PPO $12.86
Rate for Payer: PacificSource Commercial $11.81
Rate for Payer: PHCS PPO $12.86
Rate for Payer: Three Rivers PPO $9.84
Rate for Payer: TriWest Veterans Administration $8.66
Rate for Payer: United Healthcare Commercial $11.41
Rate for Payer: United Healthcare Medicare $8.66
Rate for Payer: WINHealth Partners Commercial $12.46
Rate for Payer: Wise Provider Network Commercial $12.46
Service Code NDC 6808430921
Hospital Revenue Code 250
Min. Negotiated Rate $8.23
Max. Negotiated Rate $13.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $12.86
Rate for Payer: Altius Auto/Workers Compensation $12.60
Rate for Payer: Altius Commercial $12.60
Rate for Payer: Beech Street Commercial $12.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $10.77
Rate for Payer: Cash Price $9.19
Rate for Payer: ChoiceCare Network Commercial $12.73
Rate for Payer: Cigna of WY Commercial $12.86
Rate for Payer: Entrust Commercial $12.46
Rate for Payer: First Choice Health Commercial $12.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $12.46
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.66
Rate for Payer: HealthUtah PPO $13.12
Rate for Payer: Idaho Integrated Healthcare Commercial $12.73
Rate for Payer: Multiplan Medicare/VA $8.23
Rate for Payer: One Health Plan of WY PPO $12.86
Rate for Payer: PacificSource Commercial $11.81
Rate for Payer: PHCS PPO $12.86
Rate for Payer: Three Rivers PPO $9.84
Rate for Payer: TriWest Veterans Administration $8.66
Rate for Payer: United Healthcare Commercial $11.41
Rate for Payer: United Healthcare Medicare $8.66
Rate for Payer: WINHealth Partners Commercial $12.46
Rate for Payer: Wise Provider Network Commercial $12.46
Service Code NDC 6808430921
Hospital Revenue Code 250
Min. Negotiated Rate $7.23
Max. Negotiated Rate $13.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $12.86
Rate for Payer: Aetna of WY Medicare $8.66
Rate for Payer: Altius Auto/Workers Compensation $12.60
Rate for Payer: Altius Commercial $12.60
Rate for Payer: Beech Street Commercial $12.86
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $10.77
Rate for Payer: Cash Price $9.19
Rate for Payer: ChoiceCare Network Commercial $12.73
Rate for Payer: Cigna of WY Commercial $12.86
Rate for Payer: Entrust Commercial $12.46
Rate for Payer: First Choice Health Commercial $12.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $12.46
Rate for Payer: Government Employees Health Association (GEHA) Medicare $7.61
Rate for Payer: HealthUtah PPO $13.12
Rate for Payer: Idaho Integrated Healthcare Commercial $12.73
Rate for Payer: Multiplan Medicare/VA $7.23
Rate for Payer: One Health Plan of WY PPO $12.86
Rate for Payer: PacificSource Commercial $11.81
Rate for Payer: PHCS PPO $12.86
Rate for Payer: Three Rivers PPO $9.84
Rate for Payer: TriWest Veterans Administration $7.61
Rate for Payer: United Healthcare Commercial $11.41
Rate for Payer: United Healthcare Medicare $7.61
Rate for Payer: WINHealth Partners Commercial $12.86
Rate for Payer: Wise Provider Network Commercial $12.46
Service Code NDC 3172270430
Hospital Revenue Code 250
Min. Negotiated Rate $2.04
Max. Negotiated Rate $3.26
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.19
Rate for Payer: Altius Auto/Workers Compensation $3.13
Rate for Payer: Altius Commercial $3.13
Rate for Payer: Beech Street Commercial $3.19
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.68
Rate for Payer: Cash Price $2.28
Rate for Payer: ChoiceCare Network Commercial $3.16
Rate for Payer: Cigna of WY Commercial $3.19
Rate for Payer: Entrust Commercial $3.10
Rate for Payer: First Choice Health Commercial $3.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2.15
Rate for Payer: HealthUtah PPO $3.26
Rate for Payer: Idaho Integrated Healthcare Commercial $3.16
Rate for Payer: Multiplan Medicare/VA $2.04
Rate for Payer: One Health Plan of WY PPO $3.19
Rate for Payer: PacificSource Commercial $2.93
Rate for Payer: PHCS PPO $3.19
Rate for Payer: Three Rivers PPO $2.44
Rate for Payer: TriWest Veterans Administration $2.15
Rate for Payer: United Healthcare Commercial $2.84
Rate for Payer: United Healthcare Medicare $2.15
Rate for Payer: WINHealth Partners Commercial $3.10
Rate for Payer: Wise Provider Network Commercial $3.10
Service Code NDC 3172270430
Hospital Revenue Code 250
Min. Negotiated Rate $1.80
Max. Negotiated Rate $3.26
Rate for Payer: Aetna of WY Commercial/Medical Rental $3.19
Rate for Payer: Aetna of WY Medicare $2.15
Rate for Payer: Altius Auto/Workers Compensation $3.13
Rate for Payer: Altius Commercial $3.13
Rate for Payer: Beech Street Commercial $3.19
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.68
Rate for Payer: Cash Price $2.28
Rate for Payer: ChoiceCare Network Commercial $3.16
Rate for Payer: Cigna of WY Commercial $3.19
Rate for Payer: Entrust Commercial $3.10
Rate for Payer: First Choice Health Commercial $3.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $3.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.89
Rate for Payer: HealthUtah PPO $3.26
Rate for Payer: Idaho Integrated Healthcare Commercial $3.16
Rate for Payer: Multiplan Medicare/VA $1.80
Rate for Payer: One Health Plan of WY PPO $3.19
Rate for Payer: PacificSource Commercial $2.93
Rate for Payer: PHCS PPO $3.19
Rate for Payer: Three Rivers PPO $2.44
Rate for Payer: TriWest Veterans Administration $1.89
Rate for Payer: United Healthcare Commercial $2.84
Rate for Payer: United Healthcare Medicare $1.89
Rate for Payer: WINHealth Partners Commercial $3.19
Rate for Payer: Wise Provider Network Commercial $3.10
Service Code NDC 6332349401
Hospital Revenue Code 250
Min. Negotiated Rate $12.77
Max. Negotiated Rate $20.36
Rate for Payer: Aetna of WY Commercial/Medical Rental $19.95
Rate for Payer: Altius Auto/Workers Compensation $19.55
Rate for Payer: Altius Commercial $19.55
Rate for Payer: Beech Street Commercial $19.95
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.72
Rate for Payer: Cash Price $14.25
Rate for Payer: ChoiceCare Network Commercial $19.75
Rate for Payer: Cigna of WY Commercial $19.95
Rate for Payer: Entrust Commercial $19.34
Rate for Payer: First Choice Health Commercial $19.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $19.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $13.44
Rate for Payer: HealthUtah PPO $20.36
Rate for Payer: Idaho Integrated Healthcare Commercial $19.75
Rate for Payer: Multiplan Medicare/VA $12.77
Rate for Payer: One Health Plan of WY PPO $19.95
Rate for Payer: PacificSource Commercial $18.32
Rate for Payer: PHCS PPO $19.95
Rate for Payer: Three Rivers PPO $15.27
Rate for Payer: TriWest Veterans Administration $13.44
Rate for Payer: United Healthcare Commercial $17.71
Rate for Payer: United Healthcare Medicare $13.44
Rate for Payer: WINHealth Partners Commercial $19.34
Rate for Payer: Wise Provider Network Commercial $19.34
Service Code NDC 6332349401
Hospital Revenue Code 250
Min. Negotiated Rate $11.22
Max. Negotiated Rate $20.36
Rate for Payer: Aetna of WY Commercial/Medical Rental $19.95
Rate for Payer: Aetna of WY Medicare $13.44
Rate for Payer: Altius Auto/Workers Compensation $19.55
Rate for Payer: Altius Commercial $19.55
Rate for Payer: Beech Street Commercial $19.95
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.72
Rate for Payer: Cash Price $14.25
Rate for Payer: ChoiceCare Network Commercial $19.75
Rate for Payer: Cigna of WY Commercial $19.95
Rate for Payer: Entrust Commercial $19.34
Rate for Payer: First Choice Health Commercial $19.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $19.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.81
Rate for Payer: HealthUtah PPO $20.36
Rate for Payer: Idaho Integrated Healthcare Commercial $19.75
Rate for Payer: Multiplan Medicare/VA $11.22
Rate for Payer: One Health Plan of WY PPO $19.95
Rate for Payer: PacificSource Commercial $18.32
Rate for Payer: PHCS PPO $19.95
Rate for Payer: Three Rivers PPO $15.27
Rate for Payer: TriWest Veterans Administration $11.81
Rate for Payer: United Healthcare Commercial $17.71
Rate for Payer: United Healthcare Medicare $11.81
Rate for Payer: WINHealth Partners Commercial $19.95
Rate for Payer: Wise Provider Network Commercial $19.34
Service Code NDC 6332349405
Hospital Revenue Code 250
Min. Negotiated Rate $12.77
Max. Negotiated Rate $20.36
Rate for Payer: Aetna of WY Commercial/Medical Rental $19.95
Rate for Payer: Altius Auto/Workers Compensation $19.55
Rate for Payer: Altius Commercial $19.55
Rate for Payer: Beech Street Commercial $19.95
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.72
Rate for Payer: Cash Price $14.25
Rate for Payer: ChoiceCare Network Commercial $19.75
Rate for Payer: Cigna of WY Commercial $19.95
Rate for Payer: Entrust Commercial $19.34
Rate for Payer: First Choice Health Commercial $19.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $19.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $13.44
Rate for Payer: HealthUtah PPO $20.36
Rate for Payer: Idaho Integrated Healthcare Commercial $19.75
Rate for Payer: Multiplan Medicare/VA $12.77
Rate for Payer: One Health Plan of WY PPO $19.95
Rate for Payer: PacificSource Commercial $18.32
Rate for Payer: PHCS PPO $19.95
Rate for Payer: Three Rivers PPO $15.27
Rate for Payer: TriWest Veterans Administration $13.44
Rate for Payer: United Healthcare Commercial $17.71
Rate for Payer: United Healthcare Medicare $13.44
Rate for Payer: WINHealth Partners Commercial $19.34
Rate for Payer: Wise Provider Network Commercial $19.34
Service Code NDC 6332349405
Hospital Revenue Code 250
Min. Negotiated Rate $11.22
Max. Negotiated Rate $20.36
Rate for Payer: Aetna of WY Commercial/Medical Rental $19.95
Rate for Payer: Aetna of WY Medicare $13.44
Rate for Payer: Altius Auto/Workers Compensation $19.55
Rate for Payer: Altius Commercial $19.55
Rate for Payer: Beech Street Commercial $19.95
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.72
Rate for Payer: Cash Price $14.25
Rate for Payer: ChoiceCare Network Commercial $19.75
Rate for Payer: Cigna of WY Commercial $19.95
Rate for Payer: Entrust Commercial $19.34
Rate for Payer: First Choice Health Commercial $19.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $19.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.81
Rate for Payer: HealthUtah PPO $20.36
Rate for Payer: Idaho Integrated Healthcare Commercial $19.75
Rate for Payer: Multiplan Medicare/VA $11.22
Rate for Payer: One Health Plan of WY PPO $19.95
Rate for Payer: PacificSource Commercial $18.32
Rate for Payer: PHCS PPO $19.95
Rate for Payer: Three Rivers PPO $15.27
Rate for Payer: TriWest Veterans Administration $11.81
Rate for Payer: United Healthcare Commercial $17.71
Rate for Payer: United Healthcare Medicare $11.81
Rate for Payer: WINHealth Partners Commercial $19.95
Rate for Payer: Wise Provider Network Commercial $19.34
Service Code NDC 7086078441
Hospital Revenue Code 250
Min. Negotiated Rate $11.91
Max. Negotiated Rate $19.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $18.62
Rate for Payer: Altius Auto/Workers Compensation $18.24
Rate for Payer: Altius Commercial $18.24
Rate for Payer: Beech Street Commercial $18.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $15.60
Rate for Payer: Cash Price $13.30
Rate for Payer: ChoiceCare Network Commercial $18.43
Rate for Payer: Cigna of WY Commercial $18.62
Rate for Payer: Entrust Commercial $18.05
Rate for Payer: First Choice Health Commercial $18.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $18.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $12.54
Rate for Payer: HealthUtah PPO $19.00
Rate for Payer: Idaho Integrated Healthcare Commercial $18.43
Rate for Payer: Multiplan Medicare/VA $11.91
Rate for Payer: One Health Plan of WY PPO $18.62
Rate for Payer: PacificSource Commercial $17.10
Rate for Payer: PHCS PPO $18.62
Rate for Payer: Three Rivers PPO $14.25
Rate for Payer: TriWest Veterans Administration $12.54
Rate for Payer: United Healthcare Commercial $16.53
Rate for Payer: United Healthcare Medicare $12.54
Rate for Payer: WINHealth Partners Commercial $18.05
Rate for Payer: Wise Provider Network Commercial $18.05
Service Code NDC 7086078441
Hospital Revenue Code 250
Min. Negotiated Rate $10.47
Max. Negotiated Rate $19.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $18.62
Rate for Payer: Aetna of WY Medicare $12.54
Rate for Payer: Altius Auto/Workers Compensation $18.24
Rate for Payer: Altius Commercial $18.24
Rate for Payer: Beech Street Commercial $18.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $15.60
Rate for Payer: Cash Price $13.30
Rate for Payer: ChoiceCare Network Commercial $18.43
Rate for Payer: Cigna of WY Commercial $18.62
Rate for Payer: Entrust Commercial $18.05
Rate for Payer: First Choice Health Commercial $18.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $18.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.02
Rate for Payer: HealthUtah PPO $19.00
Rate for Payer: Idaho Integrated Healthcare Commercial $18.43
Rate for Payer: Multiplan Medicare/VA $10.47
Rate for Payer: One Health Plan of WY PPO $18.62
Rate for Payer: PacificSource Commercial $17.10
Rate for Payer: PHCS PPO $18.62
Rate for Payer: Three Rivers PPO $14.25
Rate for Payer: TriWest Veterans Administration $11.02
Rate for Payer: United Healthcare Commercial $16.53
Rate for Payer: United Healthcare Medicare $11.02
Rate for Payer: WINHealth Partners Commercial $18.62
Rate for Payer: Wise Provider Network Commercial $18.05