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Service Code NDC 5511173390
Hospital Revenue Code 250
Min. Negotiated Rate $0.64
Max. Negotiated Rate $1.02
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.00
Rate for Payer: Altius Auto/Workers Compensation $0.98
Rate for Payer: Altius Commercial $0.98
Rate for Payer: Beech Street Commercial $1.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.84
Rate for Payer: Cash Price $0.72
Rate for Payer: ChoiceCare Network Commercial $0.99
Rate for Payer: Cigna of WY Commercial $1.00
Rate for Payer: Entrust Commercial $0.97
Rate for Payer: First Choice Health Commercial $0.97
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.97
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.67
Rate for Payer: HealthUtah PPO $1.02
Rate for Payer: Idaho Integrated Healthcare Commercial $0.99
Rate for Payer: Multiplan Medicare/VA $0.64
Rate for Payer: One Health Plan of WY PPO $1.00
Rate for Payer: PacificSource Commercial $0.92
Rate for Payer: PHCS PPO $1.00
Rate for Payer: Three Rivers PPO $0.77
Rate for Payer: TriWest Veterans Administration $0.67
Rate for Payer: United Healthcare Commercial $0.89
Rate for Payer: United Healthcare Medicare $0.67
Rate for Payer: WINHealth Partners Commercial $0.97
Rate for Payer: Wise Provider Network Commercial $0.97
Service Code NDC 5511173390
Hospital Revenue Code 250
Min. Negotiated Rate $0.56
Max. Negotiated Rate $1.02
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.00
Rate for Payer: Aetna of WY Medicare $0.67
Rate for Payer: Altius Auto/Workers Compensation $0.98
Rate for Payer: Altius Commercial $0.98
Rate for Payer: Beech Street Commercial $1.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.84
Rate for Payer: Cash Price $0.72
Rate for Payer: ChoiceCare Network Commercial $0.99
Rate for Payer: Cigna of WY Commercial $1.00
Rate for Payer: Entrust Commercial $0.97
Rate for Payer: First Choice Health Commercial $0.97
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.97
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.59
Rate for Payer: HealthUtah PPO $1.02
Rate for Payer: Idaho Integrated Healthcare Commercial $0.99
Rate for Payer: Multiplan Medicare/VA $0.56
Rate for Payer: One Health Plan of WY PPO $1.00
Rate for Payer: PacificSource Commercial $0.92
Rate for Payer: PHCS PPO $1.00
Rate for Payer: Three Rivers PPO $0.77
Rate for Payer: TriWest Veterans Administration $0.59
Rate for Payer: United Healthcare Commercial $0.89
Rate for Payer: United Healthcare Medicare $0.59
Rate for Payer: WINHealth Partners Commercial $1.00
Rate for Payer: Wise Provider Network Commercial $0.97
Service Code NDC 6068763411
Hospital Revenue Code 250
Min. Negotiated Rate $3.02
Max. Negotiated Rate $4.82
Rate for Payer: Aetna of WY Commercial/Medical Rental $4.72
Rate for Payer: Altius Auto/Workers Compensation $4.63
Rate for Payer: Altius Commercial $4.63
Rate for Payer: Beech Street Commercial $4.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3.96
Rate for Payer: Cash Price $3.38
Rate for Payer: ChoiceCare Network Commercial $4.68
Rate for Payer: Cigna of WY Commercial $4.72
Rate for Payer: Entrust Commercial $4.58
Rate for Payer: First Choice Health Commercial $4.58
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4.58
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3.18
Rate for Payer: HealthUtah PPO $4.82
Rate for Payer: Idaho Integrated Healthcare Commercial $4.68
Rate for Payer: Multiplan Medicare/VA $3.02
Rate for Payer: One Health Plan of WY PPO $4.72
Rate for Payer: PacificSource Commercial $4.34
Rate for Payer: PHCS PPO $4.72
Rate for Payer: Three Rivers PPO $3.62
Rate for Payer: TriWest Veterans Administration $3.18
Rate for Payer: United Healthcare Commercial $4.19
Rate for Payer: United Healthcare Medicare $3.18
Rate for Payer: WINHealth Partners Commercial $4.58
Rate for Payer: Wise Provider Network Commercial $4.58
Service Code NDC 6068763411
Hospital Revenue Code 250
Min. Negotiated Rate $2.66
Max. Negotiated Rate $4.82
Rate for Payer: Aetna of WY Commercial/Medical Rental $4.72
Rate for Payer: Aetna of WY Medicare $3.18
Rate for Payer: Altius Auto/Workers Compensation $4.63
Rate for Payer: Altius Commercial $4.63
Rate for Payer: Beech Street Commercial $4.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $3.96
Rate for Payer: Cash Price $3.38
Rate for Payer: ChoiceCare Network Commercial $4.68
Rate for Payer: Cigna of WY Commercial $4.72
Rate for Payer: Entrust Commercial $4.58
Rate for Payer: First Choice Health Commercial $4.58
Rate for Payer: Government Employees Health Association (GEHA) Commercial $4.58
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2.80
Rate for Payer: HealthUtah PPO $4.82
Rate for Payer: Idaho Integrated Healthcare Commercial $4.68
Rate for Payer: Multiplan Medicare/VA $2.66
Rate for Payer: One Health Plan of WY PPO $4.72
Rate for Payer: PacificSource Commercial $4.34
Rate for Payer: PHCS PPO $4.72
Rate for Payer: Three Rivers PPO $3.62
Rate for Payer: TriWest Veterans Administration $2.80
Rate for Payer: United Healthcare Commercial $4.19
Rate for Payer: United Healthcare Medicare $2.80
Rate for Payer: WINHealth Partners Commercial $4.72
Rate for Payer: Wise Provider Network Commercial $4.58
Service Code HCPCS J3370
Hospital Revenue Code 636
Min. Negotiated Rate $34.55
Max. Negotiated Rate $55.10
Rate for Payer: Aetna of WY Commercial/Medical Rental $54.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $32.54
Rate for Payer: Altius Auto/Workers Compensation $52.90
Rate for Payer: Altius Auto/Workers Compensation $31.87
Rate for Payer: Altius Commercial $31.87
Rate for Payer: Altius Commercial $52.90
Rate for Payer: Beech Street Commercial $54.00
Rate for Payer: Beech Street Commercial $32.54
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $27.26
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $45.24
Rate for Payer: Cash Price $38.57
Rate for Payer: Cash Price $23.24
Rate for Payer: ChoiceCare Network Commercial $32.20
Rate for Payer: ChoiceCare Network Commercial $53.45
Rate for Payer: Cigna of WY Commercial $54.00
Rate for Payer: Cigna of WY Commercial $32.54
Rate for Payer: Entrust Commercial $31.54
Rate for Payer: Entrust Commercial $52.34
Rate for Payer: First Choice Health Commercial $31.54
Rate for Payer: First Choice Health Commercial $52.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $31.54
Rate for Payer: Government Employees Health Association (GEHA) Commercial $52.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $36.37
Rate for Payer: Government Employees Health Association (GEHA) Medicare $21.91
Rate for Payer: HealthUtah PPO $55.10
Rate for Payer: HealthUtah PPO $33.20
Rate for Payer: Idaho Integrated Healthcare Commercial $32.20
Rate for Payer: Idaho Integrated Healthcare Commercial $53.45
Rate for Payer: Multiplan Medicare/VA $34.55
Rate for Payer: Multiplan Medicare/VA $20.82
Rate for Payer: One Health Plan of WY PPO $54.00
Rate for Payer: One Health Plan of WY PPO $32.54
Rate for Payer: PacificSource Commercial $49.59
Rate for Payer: PacificSource Commercial $29.88
Rate for Payer: PHCS PPO $32.54
Rate for Payer: PHCS PPO $54.00
Rate for Payer: Three Rivers PPO $24.90
Rate for Payer: Three Rivers PPO $41.32
Rate for Payer: TriWest Veterans Administration $36.37
Rate for Payer: TriWest Veterans Administration $21.91
Rate for Payer: United Healthcare Commercial $28.88
Rate for Payer: United Healthcare Commercial $47.94
Rate for Payer: United Healthcare Medicare $36.37
Rate for Payer: United Healthcare Medicare $21.91
Rate for Payer: WINHealth Partners Commercial $31.54
Rate for Payer: WINHealth Partners Commercial $52.34
Rate for Payer: Wise Provider Network Commercial $31.54
Rate for Payer: Wise Provider Network Commercial $52.34
Service Code HCPCS J3370
Hospital Revenue Code 636
Min. Negotiated Rate $30.36
Max. Negotiated Rate $55.10
Rate for Payer: Aetna of WY Commercial/Medical Rental $54.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $32.54
Rate for Payer: Aetna of WY Medicare $36.37
Rate for Payer: Aetna of WY Medicare $21.91
Rate for Payer: Altius Auto/Workers Compensation $31.87
Rate for Payer: Altius Auto/Workers Compensation $52.90
Rate for Payer: Altius Commercial $52.90
Rate for Payer: Altius Commercial $31.87
Rate for Payer: Beech Street Commercial $32.54
Rate for Payer: Beech Street Commercial $54.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $45.24
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $27.26
Rate for Payer: Cash Price $23.24
Rate for Payer: Cash Price $38.57
Rate for Payer: ChoiceCare Network Commercial $53.45
Rate for Payer: ChoiceCare Network Commercial $32.20
Rate for Payer: Cigna of WY Commercial $32.54
Rate for Payer: Cigna of WY Commercial $54.00
Rate for Payer: Entrust Commercial $52.34
Rate for Payer: Entrust Commercial $31.54
Rate for Payer: First Choice Health Commercial $31.54
Rate for Payer: First Choice Health Commercial $52.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $31.54
Rate for Payer: Government Employees Health Association (GEHA) Commercial $52.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $31.96
Rate for Payer: Government Employees Health Association (GEHA) Medicare $19.26
Rate for Payer: HealthUtah PPO $33.20
Rate for Payer: HealthUtah PPO $55.10
Rate for Payer: Idaho Integrated Healthcare Commercial $32.20
Rate for Payer: Idaho Integrated Healthcare Commercial $53.45
Rate for Payer: Multiplan Medicare/VA $30.36
Rate for Payer: Multiplan Medicare/VA $18.29
Rate for Payer: One Health Plan of WY PPO $32.54
Rate for Payer: One Health Plan of WY PPO $54.00
Rate for Payer: PacificSource Commercial $49.59
Rate for Payer: PacificSource Commercial $29.88
Rate for Payer: PHCS PPO $32.54
Rate for Payer: PHCS PPO $54.00
Rate for Payer: Three Rivers PPO $24.90
Rate for Payer: Three Rivers PPO $41.32
Rate for Payer: TriWest Veterans Administration $31.96
Rate for Payer: TriWest Veterans Administration $19.26
Rate for Payer: United Healthcare Commercial $28.88
Rate for Payer: United Healthcare Commercial $47.94
Rate for Payer: United Healthcare Medicare $31.96
Rate for Payer: United Healthcare Medicare $19.26
Rate for Payer: WINHealth Partners Commercial $32.54
Rate for Payer: WINHealth Partners Commercial $54.00
Rate for Payer: Wise Provider Network Commercial $31.54
Rate for Payer: Wise Provider Network Commercial $52.34
Service Code NDC 0121086720
Hospital Revenue Code 250
Min. Negotiated Rate $5.02
Max. Negotiated Rate $8.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $7.84
Rate for Payer: Altius Auto/Workers Compensation $7.68
Rate for Payer: Altius Commercial $7.68
Rate for Payer: Beech Street Commercial $7.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6.57
Rate for Payer: Cash Price $5.60
Rate for Payer: ChoiceCare Network Commercial $7.76
Rate for Payer: Cigna of WY Commercial $7.84
Rate for Payer: Entrust Commercial $7.60
Rate for Payer: First Choice Health Commercial $7.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5.28
Rate for Payer: HealthUtah PPO $8.00
Rate for Payer: Idaho Integrated Healthcare Commercial $7.76
Rate for Payer: Multiplan Medicare/VA $5.02
Rate for Payer: One Health Plan of WY PPO $7.84
Rate for Payer: PacificSource Commercial $7.20
Rate for Payer: PHCS PPO $7.84
Rate for Payer: Three Rivers PPO $6.00
Rate for Payer: TriWest Veterans Administration $5.28
Rate for Payer: United Healthcare Commercial $6.96
Rate for Payer: United Healthcare Medicare $5.28
Rate for Payer: WINHealth Partners Commercial $7.60
Rate for Payer: Wise Provider Network Commercial $7.60
Service Code NDC 0121086720
Hospital Revenue Code 250
Min. Negotiated Rate $4.41
Max. Negotiated Rate $8.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $7.84
Rate for Payer: Aetna of WY Medicare $5.28
Rate for Payer: Altius Auto/Workers Compensation $7.68
Rate for Payer: Altius Commercial $7.68
Rate for Payer: Beech Street Commercial $7.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6.57
Rate for Payer: Cash Price $5.60
Rate for Payer: ChoiceCare Network Commercial $7.76
Rate for Payer: Cigna of WY Commercial $7.84
Rate for Payer: Entrust Commercial $7.60
Rate for Payer: First Choice Health Commercial $7.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4.64
Rate for Payer: HealthUtah PPO $8.00
Rate for Payer: Idaho Integrated Healthcare Commercial $7.76
Rate for Payer: Multiplan Medicare/VA $4.41
Rate for Payer: One Health Plan of WY PPO $7.84
Rate for Payer: PacificSource Commercial $7.20
Rate for Payer: PHCS PPO $7.84
Rate for Payer: Three Rivers PPO $6.00
Rate for Payer: TriWest Veterans Administration $4.64
Rate for Payer: United Healthcare Commercial $6.96
Rate for Payer: United Healthcare Medicare $4.64
Rate for Payer: WINHealth Partners Commercial $7.84
Rate for Payer: Wise Provider Network Commercial $7.60
Service Code NDC 4249445020
Hospital Revenue Code 250
Min. Negotiated Rate $5.02
Max. Negotiated Rate $8.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $7.84
Rate for Payer: Altius Auto/Workers Compensation $7.68
Rate for Payer: Altius Commercial $7.68
Rate for Payer: Beech Street Commercial $7.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6.57
Rate for Payer: Cash Price $5.60
Rate for Payer: ChoiceCare Network Commercial $7.76
Rate for Payer: Cigna of WY Commercial $7.84
Rate for Payer: Entrust Commercial $7.60
Rate for Payer: First Choice Health Commercial $7.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5.28
Rate for Payer: HealthUtah PPO $8.00
Rate for Payer: Idaho Integrated Healthcare Commercial $7.76
Rate for Payer: Multiplan Medicare/VA $5.02
Rate for Payer: One Health Plan of WY PPO $7.84
Rate for Payer: PacificSource Commercial $7.20
Rate for Payer: PHCS PPO $7.84
Rate for Payer: Three Rivers PPO $6.00
Rate for Payer: TriWest Veterans Administration $5.28
Rate for Payer: United Healthcare Commercial $6.96
Rate for Payer: United Healthcare Medicare $5.28
Rate for Payer: WINHealth Partners Commercial $7.60
Rate for Payer: Wise Provider Network Commercial $7.60
Service Code NDC 4249445020
Hospital Revenue Code 250
Min. Negotiated Rate $4.41
Max. Negotiated Rate $8.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $7.84
Rate for Payer: Aetna of WY Medicare $5.28
Rate for Payer: Altius Auto/Workers Compensation $7.68
Rate for Payer: Altius Commercial $7.68
Rate for Payer: Beech Street Commercial $7.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $6.57
Rate for Payer: Cash Price $5.60
Rate for Payer: ChoiceCare Network Commercial $7.76
Rate for Payer: Cigna of WY Commercial $7.84
Rate for Payer: Entrust Commercial $7.60
Rate for Payer: First Choice Health Commercial $7.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $7.60
Rate for Payer: Government Employees Health Association (GEHA) Medicare $4.64
Rate for Payer: HealthUtah PPO $8.00
Rate for Payer: Idaho Integrated Healthcare Commercial $7.76
Rate for Payer: Multiplan Medicare/VA $4.41
Rate for Payer: One Health Plan of WY PPO $7.84
Rate for Payer: PacificSource Commercial $7.20
Rate for Payer: PHCS PPO $7.84
Rate for Payer: Three Rivers PPO $6.00
Rate for Payer: TriWest Veterans Administration $4.64
Rate for Payer: United Healthcare Commercial $6.96
Rate for Payer: United Healthcare Medicare $4.64
Rate for Payer: WINHealth Partners Commercial $7.84
Rate for Payer: Wise Provider Network Commercial $7.60
Service Code HCPCS J3372
Hospital Revenue Code 636
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.31
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.30
Rate for Payer: Altius Auto/Workers Compensation $0.30
Rate for Payer: Altius Commercial $0.30
Rate for Payer: Beech Street Commercial $0.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.25
Rate for Payer: Cash Price $0.21
Rate for Payer: ChoiceCare Network Commercial $0.30
Rate for Payer: Cigna of WY Commercial $0.30
Rate for Payer: Entrust Commercial $0.29
Rate for Payer: First Choice Health Commercial $0.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.20
Rate for Payer: HealthUtah PPO $0.31
Rate for Payer: Idaho Integrated Healthcare Commercial $0.30
Rate for Payer: Multiplan Medicare/VA $0.19
Rate for Payer: One Health Plan of WY PPO $0.30
Rate for Payer: PacificSource Commercial $0.28
Rate for Payer: PHCS PPO $0.30
Rate for Payer: Three Rivers PPO $0.23
Rate for Payer: TriWest Veterans Administration $0.20
Rate for Payer: United Healthcare Commercial $0.27
Rate for Payer: United Healthcare Medicare $0.20
Rate for Payer: WINHealth Partners Commercial $0.29
Rate for Payer: Wise Provider Network Commercial $0.29
Service Code HCPCS J3372
Hospital Revenue Code 636
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.31
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.30
Rate for Payer: Aetna of WY Medicare $0.20
Rate for Payer: Altius Auto/Workers Compensation $0.30
Rate for Payer: Altius Commercial $0.30
Rate for Payer: Beech Street Commercial $0.30
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.25
Rate for Payer: Cash Price $0.21
Rate for Payer: ChoiceCare Network Commercial $0.30
Rate for Payer: Cigna of WY Commercial $0.30
Rate for Payer: Entrust Commercial $0.29
Rate for Payer: First Choice Health Commercial $0.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.18
Rate for Payer: HealthUtah PPO $0.31
Rate for Payer: Idaho Integrated Healthcare Commercial $0.30
Rate for Payer: Multiplan Medicare/VA $0.17
Rate for Payer: One Health Plan of WY PPO $0.30
Rate for Payer: PacificSource Commercial $0.28
Rate for Payer: PHCS PPO $0.30
Rate for Payer: Three Rivers PPO $0.23
Rate for Payer: TriWest Veterans Administration $0.18
Rate for Payer: United Healthcare Commercial $0.27
Rate for Payer: United Healthcare Medicare $0.18
Rate for Payer: WINHealth Partners Commercial $0.30
Rate for Payer: Wise Provider Network Commercial $0.29
Service Code HCPCS J3372
Hospital Revenue Code 636
Min. Negotiated Rate $0.20
Max. Negotiated Rate $0.32
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.31
Rate for Payer: Altius Auto/Workers Compensation $0.31
Rate for Payer: Altius Commercial $0.31
Rate for Payer: Beech Street Commercial $0.31
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.26
Rate for Payer: Cash Price $0.22
Rate for Payer: ChoiceCare Network Commercial $0.31
Rate for Payer: Cigna of WY Commercial $0.31
Rate for Payer: Entrust Commercial $0.30
Rate for Payer: First Choice Health Commercial $0.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.21
Rate for Payer: HealthUtah PPO $0.32
Rate for Payer: Idaho Integrated Healthcare Commercial $0.31
Rate for Payer: Multiplan Medicare/VA $0.20
Rate for Payer: One Health Plan of WY PPO $0.31
Rate for Payer: PacificSource Commercial $0.29
Rate for Payer: PHCS PPO $0.31
Rate for Payer: Three Rivers PPO $0.24
Rate for Payer: TriWest Veterans Administration $0.21
Rate for Payer: United Healthcare Commercial $0.28
Rate for Payer: United Healthcare Medicare $0.21
Rate for Payer: WINHealth Partners Commercial $0.30
Rate for Payer: Wise Provider Network Commercial $0.30
Service Code HCPCS J3372
Hospital Revenue Code 636
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.32
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.31
Rate for Payer: Aetna of WY Medicare $0.21
Rate for Payer: Altius Auto/Workers Compensation $0.31
Rate for Payer: Altius Commercial $0.31
Rate for Payer: Beech Street Commercial $0.31
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.26
Rate for Payer: Cash Price $0.22
Rate for Payer: ChoiceCare Network Commercial $0.31
Rate for Payer: Cigna of WY Commercial $0.31
Rate for Payer: Entrust Commercial $0.30
Rate for Payer: First Choice Health Commercial $0.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.19
Rate for Payer: HealthUtah PPO $0.32
Rate for Payer: Idaho Integrated Healthcare Commercial $0.31
Rate for Payer: Multiplan Medicare/VA $0.18
Rate for Payer: One Health Plan of WY PPO $0.31
Rate for Payer: PacificSource Commercial $0.29
Rate for Payer: PHCS PPO $0.31
Rate for Payer: Three Rivers PPO $0.24
Rate for Payer: TriWest Veterans Administration $0.19
Rate for Payer: United Healthcare Commercial $0.28
Rate for Payer: United Healthcare Medicare $0.19
Rate for Payer: WINHealth Partners Commercial $0.31
Rate for Payer: Wise Provider Network Commercial $0.30
Service Code HCPCS J3372
Hospital Revenue Code 636
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.28
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.27
Rate for Payer: Altius Auto/Workers Compensation $0.27
Rate for Payer: Altius Commercial $0.27
Rate for Payer: Beech Street Commercial $0.27
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.23
Rate for Payer: Cash Price $0.20
Rate for Payer: ChoiceCare Network Commercial $0.27
Rate for Payer: Cigna of WY Commercial $0.27
Rate for Payer: Entrust Commercial $0.27
Rate for Payer: First Choice Health Commercial $0.27
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.27
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.18
Rate for Payer: HealthUtah PPO $0.28
Rate for Payer: Idaho Integrated Healthcare Commercial $0.27
Rate for Payer: Multiplan Medicare/VA $0.18
Rate for Payer: One Health Plan of WY PPO $0.27
Rate for Payer: PacificSource Commercial $0.25
Rate for Payer: PHCS PPO $0.27
Rate for Payer: Three Rivers PPO $0.21
Rate for Payer: TriWest Veterans Administration $0.18
Rate for Payer: United Healthcare Commercial $0.24
Rate for Payer: United Healthcare Medicare $0.18
Rate for Payer: WINHealth Partners Commercial $0.27
Rate for Payer: Wise Provider Network Commercial $0.27
Service Code HCPCS J3372
Hospital Revenue Code 636
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.28
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.27
Rate for Payer: Aetna of WY Medicare $0.18
Rate for Payer: Altius Auto/Workers Compensation $0.27
Rate for Payer: Altius Commercial $0.27
Rate for Payer: Beech Street Commercial $0.27
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.23
Rate for Payer: Cash Price $0.20
Rate for Payer: ChoiceCare Network Commercial $0.27
Rate for Payer: Cigna of WY Commercial $0.27
Rate for Payer: Entrust Commercial $0.27
Rate for Payer: First Choice Health Commercial $0.27
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.27
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.16
Rate for Payer: HealthUtah PPO $0.28
Rate for Payer: Idaho Integrated Healthcare Commercial $0.27
Rate for Payer: Multiplan Medicare/VA $0.15
Rate for Payer: One Health Plan of WY PPO $0.27
Rate for Payer: PacificSource Commercial $0.25
Rate for Payer: PHCS PPO $0.27
Rate for Payer: Three Rivers PPO $0.21
Rate for Payer: TriWest Veterans Administration $0.16
Rate for Payer: United Healthcare Commercial $0.24
Rate for Payer: United Healthcare Medicare $0.16
Rate for Payer: WINHealth Partners Commercial $0.27
Rate for Payer: Wise Provider Network Commercial $0.27
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $277.24
Max. Negotiated Rate $442.17
Rate for Payer: Aetna of WY Commercial/Medical Rental $433.33
Rate for Payer: Altius Auto/Workers Compensation $424.48
Rate for Payer: Altius Commercial $424.48
Rate for Payer: Beech Street Commercial $433.33
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $363.02
Rate for Payer: Cash Price $309.52
Rate for Payer: ChoiceCare Network Commercial $428.90
Rate for Payer: Cigna of WY Commercial $433.33
Rate for Payer: Entrust Commercial $420.06
Rate for Payer: First Choice Health Commercial $420.06
Rate for Payer: Government Employees Health Association (GEHA) Commercial $420.06
Rate for Payer: Government Employees Health Association (GEHA) Medicare $291.83
Rate for Payer: HealthUtah PPO $442.17
Rate for Payer: Idaho Integrated Healthcare Commercial $428.90
Rate for Payer: Multiplan Medicare/VA $277.24
Rate for Payer: One Health Plan of WY PPO $433.33
Rate for Payer: PacificSource Commercial $397.95
Rate for Payer: PHCS PPO $433.33
Rate for Payer: Three Rivers PPO $331.63
Rate for Payer: TriWest Veterans Administration $291.83
Rate for Payer: United Healthcare Commercial $384.69
Rate for Payer: United Healthcare Medicare $291.83
Rate for Payer: WINHealth Partners Commercial $420.06
Rate for Payer: Wise Provider Network Commercial $420.06
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $243.64
Max. Negotiated Rate $442.17
Rate for Payer: Aetna of WY Commercial/Medical Rental $433.33
Rate for Payer: Aetna of WY Medicare $291.83
Rate for Payer: Altius Auto/Workers Compensation $424.48
Rate for Payer: Altius Commercial $424.48
Rate for Payer: Beech Street Commercial $433.33
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $363.02
Rate for Payer: Cash Price $309.52
Rate for Payer: ChoiceCare Network Commercial $428.90
Rate for Payer: Cigna of WY Commercial $433.33
Rate for Payer: Entrust Commercial $420.06
Rate for Payer: First Choice Health Commercial $420.06
Rate for Payer: Government Employees Health Association (GEHA) Commercial $420.06
Rate for Payer: Government Employees Health Association (GEHA) Medicare $256.46
Rate for Payer: HealthUtah PPO $442.17
Rate for Payer: Idaho Integrated Healthcare Commercial $428.90
Rate for Payer: Multiplan Medicare/VA $243.64
Rate for Payer: One Health Plan of WY PPO $433.33
Rate for Payer: PacificSource Commercial $397.95
Rate for Payer: PHCS PPO $433.33
Rate for Payer: Three Rivers PPO $331.63
Rate for Payer: TriWest Veterans Administration $256.46
Rate for Payer: United Healthcare Commercial $384.69
Rate for Payer: United Healthcare Medicare $256.46
Rate for Payer: WINHealth Partners Commercial $433.33
Rate for Payer: Wise Provider Network Commercial $420.06
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $507.20
Max. Negotiated Rate $920.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $902.09
Rate for Payer: Aetna of WY Medicare $607.53
Rate for Payer: Altius Auto/Workers Compensation $883.68
Rate for Payer: Altius Commercial $883.68
Rate for Payer: Beech Street Commercial $902.09
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $755.73
Rate for Payer: Cash Price $644.35
Rate for Payer: ChoiceCare Network Commercial $892.88
Rate for Payer: Cigna of WY Commercial $902.09
Rate for Payer: Entrust Commercial $874.48
Rate for Payer: First Choice Health Commercial $874.48
Rate for Payer: Government Employees Health Association (GEHA) Commercial $874.48
Rate for Payer: Government Employees Health Association (GEHA) Medicare $533.89
Rate for Payer: HealthUtah PPO $920.50
Rate for Payer: Idaho Integrated Healthcare Commercial $892.88
Rate for Payer: Multiplan Medicare/VA $507.20
Rate for Payer: One Health Plan of WY PPO $902.09
Rate for Payer: PacificSource Commercial $828.45
Rate for Payer: PHCS PPO $902.09
Rate for Payer: Three Rivers PPO $690.38
Rate for Payer: TriWest Veterans Administration $533.89
Rate for Payer: United Healthcare Commercial $800.84
Rate for Payer: United Healthcare Medicare $533.89
Rate for Payer: WINHealth Partners Commercial $902.09
Rate for Payer: Wise Provider Network Commercial $874.48
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $577.15
Max. Negotiated Rate $920.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $902.09
Rate for Payer: Altius Auto/Workers Compensation $883.68
Rate for Payer: Altius Commercial $883.68
Rate for Payer: Beech Street Commercial $902.09
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $755.73
Rate for Payer: Cash Price $644.35
Rate for Payer: ChoiceCare Network Commercial $892.88
Rate for Payer: Cigna of WY Commercial $902.09
Rate for Payer: Entrust Commercial $874.48
Rate for Payer: First Choice Health Commercial $874.48
Rate for Payer: Government Employees Health Association (GEHA) Commercial $874.48
Rate for Payer: Government Employees Health Association (GEHA) Medicare $607.53
Rate for Payer: HealthUtah PPO $920.50
Rate for Payer: Idaho Integrated Healthcare Commercial $892.88
Rate for Payer: Multiplan Medicare/VA $577.15
Rate for Payer: One Health Plan of WY PPO $902.09
Rate for Payer: PacificSource Commercial $828.45
Rate for Payer: PHCS PPO $902.09
Rate for Payer: Three Rivers PPO $690.38
Rate for Payer: TriWest Veterans Administration $607.53
Rate for Payer: United Healthcare Commercial $800.84
Rate for Payer: United Healthcare Medicare $607.53
Rate for Payer: WINHealth Partners Commercial $874.48
Rate for Payer: Wise Provider Network Commercial $874.48
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $622.91
Max. Negotiated Rate $1,130.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,107.89
Rate for Payer: Aetna of WY Medicare $746.13
Rate for Payer: Altius Auto/Workers Compensation $1,085.28
Rate for Payer: Altius Commercial $1,085.28
Rate for Payer: Beech Street Commercial $1,107.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $928.14
Rate for Payer: Cash Price $791.35
Rate for Payer: ChoiceCare Network Commercial $1,096.58
Rate for Payer: Cigna of WY Commercial $1,107.89
Rate for Payer: Entrust Commercial $1,073.98
Rate for Payer: First Choice Health Commercial $1,073.98
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,073.98
Rate for Payer: Government Employees Health Association (GEHA) Medicare $655.69
Rate for Payer: HealthUtah PPO $1,130.50
Rate for Payer: Idaho Integrated Healthcare Commercial $1,096.58
Rate for Payer: Multiplan Medicare/VA $622.91
Rate for Payer: One Health Plan of WY PPO $1,107.89
Rate for Payer: PacificSource Commercial $1,017.45
Rate for Payer: PHCS PPO $1,107.89
Rate for Payer: Three Rivers PPO $847.88
Rate for Payer: TriWest Veterans Administration $655.69
Rate for Payer: United Healthcare Commercial $983.54
Rate for Payer: United Healthcare Medicare $655.69
Rate for Payer: WINHealth Partners Commercial $1,107.89
Rate for Payer: Wise Provider Network Commercial $1,073.98
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $708.82
Max. Negotiated Rate $1,130.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,107.89
Rate for Payer: Altius Auto/Workers Compensation $1,085.28
Rate for Payer: Altius Commercial $1,085.28
Rate for Payer: Beech Street Commercial $1,107.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $928.14
Rate for Payer: Cash Price $791.35
Rate for Payer: ChoiceCare Network Commercial $1,096.58
Rate for Payer: Cigna of WY Commercial $1,107.89
Rate for Payer: Entrust Commercial $1,073.98
Rate for Payer: First Choice Health Commercial $1,073.98
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,073.98
Rate for Payer: Government Employees Health Association (GEHA) Medicare $746.13
Rate for Payer: HealthUtah PPO $1,130.50
Rate for Payer: Idaho Integrated Healthcare Commercial $1,096.58
Rate for Payer: Multiplan Medicare/VA $708.82
Rate for Payer: One Health Plan of WY PPO $1,107.89
Rate for Payer: PacificSource Commercial $1,017.45
Rate for Payer: PHCS PPO $1,107.89
Rate for Payer: Three Rivers PPO $847.88
Rate for Payer: TriWest Veterans Administration $746.13
Rate for Payer: United Healthcare Commercial $983.54
Rate for Payer: United Healthcare Medicare $746.13
Rate for Payer: WINHealth Partners Commercial $1,073.98
Rate for Payer: Wise Provider Network Commercial $1,073.98
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $539.85
Max. Negotiated Rate $861.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $843.78
Rate for Payer: Altius Auto/Workers Compensation $826.56
Rate for Payer: Altius Commercial $826.56
Rate for Payer: Beech Street Commercial $843.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $706.88
Rate for Payer: Cash Price $602.70
Rate for Payer: ChoiceCare Network Commercial $835.17
Rate for Payer: Cigna of WY Commercial $843.78
Rate for Payer: Entrust Commercial $817.95
Rate for Payer: First Choice Health Commercial $817.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $817.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $568.26
Rate for Payer: HealthUtah PPO $861.00
Rate for Payer: Idaho Integrated Healthcare Commercial $835.17
Rate for Payer: Multiplan Medicare/VA $539.85
Rate for Payer: One Health Plan of WY PPO $843.78
Rate for Payer: PacificSource Commercial $774.90
Rate for Payer: PHCS PPO $843.78
Rate for Payer: Three Rivers PPO $645.75
Rate for Payer: TriWest Veterans Administration $568.26
Rate for Payer: United Healthcare Commercial $749.07
Rate for Payer: United Healthcare Medicare $568.26
Rate for Payer: WINHealth Partners Commercial $817.95
Rate for Payer: Wise Provider Network Commercial $817.95
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $474.41
Max. Negotiated Rate $861.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $843.78
Rate for Payer: Aetna of WY Medicare $568.26
Rate for Payer: Altius Auto/Workers Compensation $826.56
Rate for Payer: Altius Commercial $826.56
Rate for Payer: Beech Street Commercial $843.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $706.88
Rate for Payer: Cash Price $602.70
Rate for Payer: ChoiceCare Network Commercial $835.17
Rate for Payer: Cigna of WY Commercial $843.78
Rate for Payer: Entrust Commercial $817.95
Rate for Payer: First Choice Health Commercial $817.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $817.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $499.38
Rate for Payer: HealthUtah PPO $861.00
Rate for Payer: Idaho Integrated Healthcare Commercial $835.17
Rate for Payer: Multiplan Medicare/VA $474.41
Rate for Payer: One Health Plan of WY PPO $843.78
Rate for Payer: PacificSource Commercial $774.90
Rate for Payer: PHCS PPO $843.78
Rate for Payer: Three Rivers PPO $645.75
Rate for Payer: TriWest Veterans Administration $499.38
Rate for Payer: United Healthcare Commercial $749.07
Rate for Payer: United Healthcare Medicare $499.38
Rate for Payer: WINHealth Partners Commercial $843.78
Rate for Payer: Wise Provider Network Commercial $817.95
Service Code NDC 0006482700
Hospital Revenue Code 250
Min. Negotiated Rate $180.81
Max. Negotiated Rate $288.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $282.61
Rate for Payer: Altius Auto/Workers Compensation $276.84
Rate for Payer: Altius Commercial $276.84
Rate for Payer: Beech Street Commercial $282.61
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $236.76
Rate for Payer: Cash Price $201.86
Rate for Payer: ChoiceCare Network Commercial $279.73
Rate for Payer: Cigna of WY Commercial $282.61
Rate for Payer: Entrust Commercial $273.96
Rate for Payer: First Choice Health Commercial $273.96
Rate for Payer: Government Employees Health Association (GEHA) Commercial $273.96
Rate for Payer: Government Employees Health Association (GEHA) Medicare $190.33
Rate for Payer: HealthUtah PPO $288.38
Rate for Payer: Idaho Integrated Healthcare Commercial $279.73
Rate for Payer: Multiplan Medicare/VA $180.81
Rate for Payer: One Health Plan of WY PPO $282.61
Rate for Payer: PacificSource Commercial $259.54
Rate for Payer: PHCS PPO $282.61
Rate for Payer: Three Rivers PPO $216.28
Rate for Payer: TriWest Veterans Administration $190.33
Rate for Payer: United Healthcare Commercial $250.89
Rate for Payer: United Healthcare Medicare $190.33
Rate for Payer: WINHealth Partners Commercial $273.96
Rate for Payer: Wise Provider Network Commercial $273.96