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Service Code NDC 0006482700
Hospital Revenue Code 250
Min. Negotiated Rate $158.90
Max. Negotiated Rate $288.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $282.61
Rate for Payer: Aetna of WY Medicare $190.33
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 $167.26
Rate for Payer: HealthUtah PPO $288.38
Rate for Payer: Idaho Integrated Healthcare Commercial $279.73
Rate for Payer: Multiplan Medicare/VA $158.90
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 $167.26
Rate for Payer: United Healthcare Commercial $250.89
Rate for Payer: United Healthcare Medicare $167.26
Rate for Payer: WINHealth Partners Commercial $282.61
Rate for Payer: Wise Provider Network Commercial $273.96
Service Code NDC 5816082311
Hospital Revenue Code 250
Min. Negotiated Rate $168.90
Max. Negotiated Rate $269.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $263.99
Rate for Payer: Altius Auto/Workers Compensation $258.60
Rate for Payer: Altius Commercial $258.60
Rate for Payer: Beech Street Commercial $263.99
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $221.16
Rate for Payer: Cash Price $188.57
Rate for Payer: ChoiceCare Network Commercial $261.30
Rate for Payer: Cigna of WY Commercial $263.99
Rate for Payer: Entrust Commercial $255.91
Rate for Payer: First Choice Health Commercial $255.91
Rate for Payer: Government Employees Health Association (GEHA) Commercial $255.91
Rate for Payer: Government Employees Health Association (GEHA) Medicare $177.79
Rate for Payer: HealthUtah PPO $269.38
Rate for Payer: Idaho Integrated Healthcare Commercial $261.30
Rate for Payer: Multiplan Medicare/VA $168.90
Rate for Payer: One Health Plan of WY PPO $263.99
Rate for Payer: PacificSource Commercial $242.44
Rate for Payer: PHCS PPO $263.99
Rate for Payer: Three Rivers PPO $202.04
Rate for Payer: TriWest Veterans Administration $177.79
Rate for Payer: United Healthcare Commercial $234.36
Rate for Payer: United Healthcare Medicare $177.79
Rate for Payer: WINHealth Partners Commercial $255.91
Rate for Payer: Wise Provider Network Commercial $255.91
Service Code NDC 5816082311
Hospital Revenue Code 250
Min. Negotiated Rate $148.43
Max. Negotiated Rate $269.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $263.99
Rate for Payer: Aetna of WY Medicare $177.79
Rate for Payer: Altius Auto/Workers Compensation $258.60
Rate for Payer: Altius Commercial $258.60
Rate for Payer: Beech Street Commercial $263.99
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $221.16
Rate for Payer: Cash Price $188.57
Rate for Payer: ChoiceCare Network Commercial $261.30
Rate for Payer: Cigna of WY Commercial $263.99
Rate for Payer: Entrust Commercial $255.91
Rate for Payer: First Choice Health Commercial $255.91
Rate for Payer: Government Employees Health Association (GEHA) Commercial $255.91
Rate for Payer: Government Employees Health Association (GEHA) Medicare $156.24
Rate for Payer: HealthUtah PPO $269.38
Rate for Payer: Idaho Integrated Healthcare Commercial $261.30
Rate for Payer: Multiplan Medicare/VA $148.43
Rate for Payer: One Health Plan of WY PPO $263.99
Rate for Payer: PacificSource Commercial $242.44
Rate for Payer: PHCS PPO $263.99
Rate for Payer: Three Rivers PPO $202.04
Rate for Payer: TriWest Veterans Administration $156.24
Rate for Payer: United Healthcare Commercial $234.36
Rate for Payer: United Healthcare Medicare $156.24
Rate for Payer: WINHealth Partners Commercial $263.99
Rate for Payer: Wise Provider Network Commercial $255.91
Service Code NDC 5816082803
Hospital Revenue Code 250
Min. Negotiated Rate $168.90
Max. Negotiated Rate $269.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $263.99
Rate for Payer: Altius Auto/Workers Compensation $258.60
Rate for Payer: Altius Commercial $258.60
Rate for Payer: Beech Street Commercial $263.99
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $221.16
Rate for Payer: Cash Price $188.57
Rate for Payer: ChoiceCare Network Commercial $261.30
Rate for Payer: Cigna of WY Commercial $263.99
Rate for Payer: Entrust Commercial $255.91
Rate for Payer: First Choice Health Commercial $255.91
Rate for Payer: Government Employees Health Association (GEHA) Commercial $255.91
Rate for Payer: Government Employees Health Association (GEHA) Medicare $177.79
Rate for Payer: HealthUtah PPO $269.38
Rate for Payer: Idaho Integrated Healthcare Commercial $261.30
Rate for Payer: Multiplan Medicare/VA $168.90
Rate for Payer: One Health Plan of WY PPO $263.99
Rate for Payer: PacificSource Commercial $242.44
Rate for Payer: PHCS PPO $263.99
Rate for Payer: Three Rivers PPO $202.04
Rate for Payer: TriWest Veterans Administration $177.79
Rate for Payer: United Healthcare Commercial $234.36
Rate for Payer: United Healthcare Medicare $177.79
Rate for Payer: WINHealth Partners Commercial $255.91
Rate for Payer: Wise Provider Network Commercial $255.91
Service Code NDC 5816082803
Hospital Revenue Code 250
Min. Negotiated Rate $148.43
Max. Negotiated Rate $269.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $263.99
Rate for Payer: Aetna of WY Medicare $177.79
Rate for Payer: Altius Auto/Workers Compensation $258.60
Rate for Payer: Altius Commercial $258.60
Rate for Payer: Beech Street Commercial $263.99
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $221.16
Rate for Payer: Cash Price $188.57
Rate for Payer: ChoiceCare Network Commercial $261.30
Rate for Payer: Cigna of WY Commercial $263.99
Rate for Payer: Entrust Commercial $255.91
Rate for Payer: First Choice Health Commercial $255.91
Rate for Payer: Government Employees Health Association (GEHA) Commercial $255.91
Rate for Payer: Government Employees Health Association (GEHA) Medicare $156.24
Rate for Payer: HealthUtah PPO $269.38
Rate for Payer: Idaho Integrated Healthcare Commercial $261.30
Rate for Payer: Multiplan Medicare/VA $148.43
Rate for Payer: One Health Plan of WY PPO $263.99
Rate for Payer: PacificSource Commercial $242.44
Rate for Payer: PHCS PPO $263.99
Rate for Payer: Three Rivers PPO $202.04
Rate for Payer: TriWest Veterans Administration $156.24
Rate for Payer: United Healthcare Commercial $234.36
Rate for Payer: United Healthcare Medicare $156.24
Rate for Payer: WINHealth Partners Commercial $263.99
Rate for Payer: Wise Provider Network Commercial $255.91
Service Code HCPCS 90716
Hospital Charge Code 90716
Min. Negotiated Rate $362.25
Max. Negotiated Rate $483.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $473.34
Rate for Payer: Beech Street Commercial $458.85
Rate for Payer: Cash Price $338.10
Rate for Payer: ChoiceCare Network Commercial $468.51
Rate for Payer: Cigna of WY Commercial $473.34
Rate for Payer: First Choice Health Commercial $434.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $458.85
Rate for Payer: HealthUtah PPO $483.00
Rate for Payer: Idaho Integrated Healthcare Commercial $468.51
Rate for Payer: One Health Plan of WY PPO $473.34
Rate for Payer: PacificSource Commercial $434.70
Rate for Payer: PHCS PPO $458.85
Rate for Payer: Three Rivers PPO $362.25
Rate for Payer: United Healthcare Commercial $420.21
Rate for Payer: WINHealth Partners Commercial $483.00
Service Code HCPCS 55250
Hospital Charge Code 55250
Min. Negotiated Rate $858.00
Max. Negotiated Rate $1,144.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,121.12
Rate for Payer: Beech Street Commercial $1,086.80
Rate for Payer: Cash Price $800.80
Rate for Payer: ChoiceCare Network Commercial $1,109.68
Rate for Payer: Cigna of WY Commercial $1,121.12
Rate for Payer: First Choice Health Commercial $1,029.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,086.80
Rate for Payer: HealthUtah PPO $1,144.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,109.68
Rate for Payer: One Health Plan of WY PPO $1,121.12
Rate for Payer: PacificSource Commercial $1,029.60
Rate for Payer: PHCS PPO $1,086.80
Rate for Payer: Three Rivers PPO $858.00
Rate for Payer: United Healthcare Commercial $995.28
Rate for Payer: WINHealth Partners Commercial $972.40
Service Code HCPCS J2599
Hospital Revenue Code 636
Min. Negotiated Rate $108.26
Max. Negotiated Rate $172.66
Rate for Payer: Aetna of WY Commercial/Medical Rental $169.21
Rate for Payer: Altius Auto/Workers Compensation $165.75
Rate for Payer: Altius Commercial $165.75
Rate for Payer: Beech Street Commercial $169.21
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $141.75
Rate for Payer: Cash Price $120.86
Rate for Payer: ChoiceCare Network Commercial $167.48
Rate for Payer: Cigna of WY Commercial $169.21
Rate for Payer: Entrust Commercial $164.03
Rate for Payer: First Choice Health Commercial $164.03
Rate for Payer: Government Employees Health Association (GEHA) Commercial $164.03
Rate for Payer: Government Employees Health Association (GEHA) Medicare $113.96
Rate for Payer: HealthUtah PPO $172.66
Rate for Payer: Idaho Integrated Healthcare Commercial $167.48
Rate for Payer: Multiplan Medicare/VA $108.26
Rate for Payer: One Health Plan of WY PPO $169.21
Rate for Payer: PacificSource Commercial $155.39
Rate for Payer: PHCS PPO $169.21
Rate for Payer: Three Rivers PPO $129.50
Rate for Payer: TriWest Veterans Administration $113.96
Rate for Payer: United Healthcare Commercial $150.21
Rate for Payer: United Healthcare Medicare $113.96
Rate for Payer: WINHealth Partners Commercial $164.03
Rate for Payer: Wise Provider Network Commercial $164.03
Service Code HCPCS J2599
Hospital Revenue Code 636
Min. Negotiated Rate $95.14
Max. Negotiated Rate $172.66
Rate for Payer: Aetna of WY Commercial/Medical Rental $169.21
Rate for Payer: Aetna of WY Medicare $113.96
Rate for Payer: Altius Auto/Workers Compensation $165.75
Rate for Payer: Altius Commercial $165.75
Rate for Payer: Beech Street Commercial $169.21
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $141.75
Rate for Payer: Cash Price $120.86
Rate for Payer: ChoiceCare Network Commercial $167.48
Rate for Payer: Cigna of WY Commercial $169.21
Rate for Payer: Entrust Commercial $164.03
Rate for Payer: First Choice Health Commercial $164.03
Rate for Payer: Government Employees Health Association (GEHA) Commercial $164.03
Rate for Payer: Government Employees Health Association (GEHA) Medicare $100.14
Rate for Payer: HealthUtah PPO $172.66
Rate for Payer: Idaho Integrated Healthcare Commercial $167.48
Rate for Payer: Multiplan Medicare/VA $95.14
Rate for Payer: One Health Plan of WY PPO $169.21
Rate for Payer: PacificSource Commercial $155.39
Rate for Payer: PHCS PPO $169.21
Rate for Payer: Three Rivers PPO $129.50
Rate for Payer: TriWest Veterans Administration $100.14
Rate for Payer: United Healthcare Commercial $150.21
Rate for Payer: United Healthcare Medicare $100.14
Rate for Payer: WINHealth Partners Commercial $169.21
Rate for Payer: Wise Provider Network Commercial $164.03
Service Code NDC 0409163221
Hospital Revenue Code 250
Min. Negotiated Rate $25.51
Max. Negotiated Rate $40.69
Rate for Payer: Aetna of WY Commercial/Medical Rental $39.88
Rate for Payer: Altius Auto/Workers Compensation $39.06
Rate for Payer: Altius Commercial $39.06
Rate for Payer: Beech Street Commercial $39.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $33.41
Rate for Payer: Cash Price $28.48
Rate for Payer: ChoiceCare Network Commercial $39.47
Rate for Payer: Cigna of WY Commercial $39.88
Rate for Payer: Entrust Commercial $38.66
Rate for Payer: First Choice Health Commercial $38.66
Rate for Payer: Government Employees Health Association (GEHA) Commercial $38.66
Rate for Payer: Government Employees Health Association (GEHA) Medicare $26.86
Rate for Payer: HealthUtah PPO $40.69
Rate for Payer: Idaho Integrated Healthcare Commercial $39.47
Rate for Payer: Multiplan Medicare/VA $25.51
Rate for Payer: One Health Plan of WY PPO $39.88
Rate for Payer: PacificSource Commercial $36.62
Rate for Payer: PHCS PPO $39.88
Rate for Payer: Three Rivers PPO $30.52
Rate for Payer: TriWest Veterans Administration $26.86
Rate for Payer: United Healthcare Commercial $35.40
Rate for Payer: United Healthcare Medicare $26.86
Rate for Payer: WINHealth Partners Commercial $38.66
Rate for Payer: Wise Provider Network Commercial $38.66
Service Code NDC 0409163221
Hospital Revenue Code 250
Min. Negotiated Rate $22.42
Max. Negotiated Rate $40.69
Rate for Payer: Aetna of WY Commercial/Medical Rental $39.88
Rate for Payer: Aetna of WY Medicare $26.86
Rate for Payer: Altius Auto/Workers Compensation $39.06
Rate for Payer: Altius Commercial $39.06
Rate for Payer: Beech Street Commercial $39.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $33.41
Rate for Payer: Cash Price $28.48
Rate for Payer: ChoiceCare Network Commercial $39.47
Rate for Payer: Cigna of WY Commercial $39.88
Rate for Payer: Entrust Commercial $38.66
Rate for Payer: First Choice Health Commercial $38.66
Rate for Payer: Government Employees Health Association (GEHA) Commercial $38.66
Rate for Payer: Government Employees Health Association (GEHA) Medicare $23.60
Rate for Payer: HealthUtah PPO $40.69
Rate for Payer: Idaho Integrated Healthcare Commercial $39.47
Rate for Payer: Multiplan Medicare/VA $22.42
Rate for Payer: One Health Plan of WY PPO $39.88
Rate for Payer: PacificSource Commercial $36.62
Rate for Payer: PHCS PPO $39.88
Rate for Payer: Three Rivers PPO $30.52
Rate for Payer: TriWest Veterans Administration $23.60
Rate for Payer: United Healthcare Commercial $35.40
Rate for Payer: United Healthcare Medicare $23.60
Rate for Payer: WINHealth Partners Commercial $39.88
Rate for Payer: Wise Provider Network Commercial $38.66
Service Code NDC 4733593140
Hospital Revenue Code 250
Min. Negotiated Rate $26.72
Max. Negotiated Rate $42.62
Rate for Payer: Aetna of WY Commercial/Medical Rental $41.77
Rate for Payer: Altius Auto/Workers Compensation $40.92
Rate for Payer: Altius Commercial $40.92
Rate for Payer: Beech Street Commercial $41.77
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $34.99
Rate for Payer: Cash Price $29.84
Rate for Payer: ChoiceCare Network Commercial $41.34
Rate for Payer: Cigna of WY Commercial $41.77
Rate for Payer: Entrust Commercial $40.49
Rate for Payer: First Choice Health Commercial $40.49
Rate for Payer: Government Employees Health Association (GEHA) Commercial $40.49
Rate for Payer: Government Employees Health Association (GEHA) Medicare $28.13
Rate for Payer: HealthUtah PPO $42.62
Rate for Payer: Idaho Integrated Healthcare Commercial $41.34
Rate for Payer: Multiplan Medicare/VA $26.72
Rate for Payer: One Health Plan of WY PPO $41.77
Rate for Payer: PacificSource Commercial $38.36
Rate for Payer: PHCS PPO $41.77
Rate for Payer: Three Rivers PPO $31.96
Rate for Payer: TriWest Veterans Administration $28.13
Rate for Payer: United Healthcare Commercial $37.08
Rate for Payer: United Healthcare Medicare $28.13
Rate for Payer: WINHealth Partners Commercial $40.49
Rate for Payer: Wise Provider Network Commercial $40.49
Service Code NDC 4733593140
Hospital Revenue Code 250
Min. Negotiated Rate $23.48
Max. Negotiated Rate $42.62
Rate for Payer: Aetna of WY Commercial/Medical Rental $41.77
Rate for Payer: Aetna of WY Medicare $28.13
Rate for Payer: Altius Auto/Workers Compensation $40.92
Rate for Payer: Altius Commercial $40.92
Rate for Payer: Beech Street Commercial $41.77
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $34.99
Rate for Payer: Cash Price $29.84
Rate for Payer: ChoiceCare Network Commercial $41.34
Rate for Payer: Cigna of WY Commercial $41.77
Rate for Payer: Entrust Commercial $40.49
Rate for Payer: First Choice Health Commercial $40.49
Rate for Payer: Government Employees Health Association (GEHA) Commercial $40.49
Rate for Payer: Government Employees Health Association (GEHA) Medicare $24.72
Rate for Payer: HealthUtah PPO $42.62
Rate for Payer: Idaho Integrated Healthcare Commercial $41.34
Rate for Payer: Multiplan Medicare/VA $23.48
Rate for Payer: One Health Plan of WY PPO $41.77
Rate for Payer: PacificSource Commercial $38.36
Rate for Payer: PHCS PPO $41.77
Rate for Payer: Three Rivers PPO $31.96
Rate for Payer: TriWest Veterans Administration $24.72
Rate for Payer: United Healthcare Commercial $37.08
Rate for Payer: United Healthcare Medicare $24.72
Rate for Payer: WINHealth Partners Commercial $41.77
Rate for Payer: Wise Provider Network Commercial $40.49
Service Code NDC 5515023501
Hospital Revenue Code 250
Min. Negotiated Rate $19.75
Max. Negotiated Rate $31.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.87
Rate for Payer: Altius Auto/Workers Compensation $30.24
Rate for Payer: Altius Commercial $30.24
Rate for Payer: Beech Street Commercial $30.87
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.86
Rate for Payer: Cash Price $22.05
Rate for Payer: ChoiceCare Network Commercial $30.56
Rate for Payer: Cigna of WY Commercial $30.87
Rate for Payer: Entrust Commercial $29.92
Rate for Payer: First Choice Health Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $20.79
Rate for Payer: HealthUtah PPO $31.50
Rate for Payer: Idaho Integrated Healthcare Commercial $30.56
Rate for Payer: Multiplan Medicare/VA $19.75
Rate for Payer: One Health Plan of WY PPO $30.87
Rate for Payer: PacificSource Commercial $28.35
Rate for Payer: PHCS PPO $30.87
Rate for Payer: Three Rivers PPO $23.62
Rate for Payer: TriWest Veterans Administration $20.79
Rate for Payer: United Healthcare Commercial $27.40
Rate for Payer: United Healthcare Medicare $20.79
Rate for Payer: WINHealth Partners Commercial $29.92
Rate for Payer: Wise Provider Network Commercial $29.92
Service Code NDC 5515023501
Hospital Revenue Code 250
Min. Negotiated Rate $17.36
Max. Negotiated Rate $31.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.87
Rate for Payer: Aetna of WY Medicare $20.79
Rate for Payer: Altius Auto/Workers Compensation $30.24
Rate for Payer: Altius Commercial $30.24
Rate for Payer: Beech Street Commercial $30.87
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.86
Rate for Payer: Cash Price $22.05
Rate for Payer: ChoiceCare Network Commercial $30.56
Rate for Payer: Cigna of WY Commercial $30.87
Rate for Payer: Entrust Commercial $29.92
Rate for Payer: First Choice Health Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.27
Rate for Payer: HealthUtah PPO $31.50
Rate for Payer: Idaho Integrated Healthcare Commercial $30.56
Rate for Payer: Multiplan Medicare/VA $17.36
Rate for Payer: One Health Plan of WY PPO $30.87
Rate for Payer: PacificSource Commercial $28.35
Rate for Payer: PHCS PPO $30.87
Rate for Payer: Three Rivers PPO $23.62
Rate for Payer: TriWest Veterans Administration $18.27
Rate for Payer: United Healthcare Commercial $27.40
Rate for Payer: United Healthcare Medicare $18.27
Rate for Payer: WINHealth Partners Commercial $30.87
Rate for Payer: Wise Provider Network Commercial $29.92
Service Code NDC 5515023510
Hospital Revenue Code 250
Min. Negotiated Rate $19.75
Max. Negotiated Rate $31.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.87
Rate for Payer: Altius Auto/Workers Compensation $30.24
Rate for Payer: Altius Commercial $30.24
Rate for Payer: Beech Street Commercial $30.87
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.86
Rate for Payer: Cash Price $22.05
Rate for Payer: ChoiceCare Network Commercial $30.56
Rate for Payer: Cigna of WY Commercial $30.87
Rate for Payer: Entrust Commercial $29.92
Rate for Payer: First Choice Health Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $20.79
Rate for Payer: HealthUtah PPO $31.50
Rate for Payer: Idaho Integrated Healthcare Commercial $30.56
Rate for Payer: Multiplan Medicare/VA $19.75
Rate for Payer: One Health Plan of WY PPO $30.87
Rate for Payer: PacificSource Commercial $28.35
Rate for Payer: PHCS PPO $30.87
Rate for Payer: Three Rivers PPO $23.62
Rate for Payer: TriWest Veterans Administration $20.79
Rate for Payer: United Healthcare Commercial $27.40
Rate for Payer: United Healthcare Medicare $20.79
Rate for Payer: WINHealth Partners Commercial $29.92
Rate for Payer: Wise Provider Network Commercial $29.92
Service Code NDC 5515023510
Hospital Revenue Code 250
Min. Negotiated Rate $17.36
Max. Negotiated Rate $31.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.87
Rate for Payer: Aetna of WY Medicare $20.79
Rate for Payer: Altius Auto/Workers Compensation $30.24
Rate for Payer: Altius Commercial $30.24
Rate for Payer: Beech Street Commercial $30.87
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.86
Rate for Payer: Cash Price $22.05
Rate for Payer: ChoiceCare Network Commercial $30.56
Rate for Payer: Cigna of WY Commercial $30.87
Rate for Payer: Entrust Commercial $29.92
Rate for Payer: First Choice Health Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.27
Rate for Payer: HealthUtah PPO $31.50
Rate for Payer: Idaho Integrated Healthcare Commercial $30.56
Rate for Payer: Multiplan Medicare/VA $17.36
Rate for Payer: One Health Plan of WY PPO $30.87
Rate for Payer: PacificSource Commercial $28.35
Rate for Payer: PHCS PPO $30.87
Rate for Payer: Three Rivers PPO $23.62
Rate for Payer: TriWest Veterans Administration $18.27
Rate for Payer: United Healthcare Commercial $27.40
Rate for Payer: United Healthcare Medicare $18.27
Rate for Payer: WINHealth Partners Commercial $30.87
Rate for Payer: Wise Provider Network Commercial $29.92
Service Code NDC 5515023501
Hospital Revenue Code 250
Min. Negotiated Rate $19.75
Max. Negotiated Rate $31.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.87
Rate for Payer: Altius Auto/Workers Compensation $30.24
Rate for Payer: Altius Commercial $30.24
Rate for Payer: Beech Street Commercial $30.87
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.86
Rate for Payer: Cash Price $22.05
Rate for Payer: ChoiceCare Network Commercial $30.56
Rate for Payer: Cigna of WY Commercial $30.87
Rate for Payer: Entrust Commercial $29.92
Rate for Payer: First Choice Health Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $20.79
Rate for Payer: HealthUtah PPO $31.50
Rate for Payer: Idaho Integrated Healthcare Commercial $30.56
Rate for Payer: Multiplan Medicare/VA $19.75
Rate for Payer: One Health Plan of WY PPO $30.87
Rate for Payer: PacificSource Commercial $28.35
Rate for Payer: PHCS PPO $30.87
Rate for Payer: Three Rivers PPO $23.62
Rate for Payer: TriWest Veterans Administration $20.79
Rate for Payer: United Healthcare Commercial $27.40
Rate for Payer: United Healthcare Medicare $20.79
Rate for Payer: WINHealth Partners Commercial $29.92
Rate for Payer: Wise Provider Network Commercial $29.92
Service Code NDC 5515023501
Hospital Revenue Code 250
Min. Negotiated Rate $17.36
Max. Negotiated Rate $31.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.87
Rate for Payer: Aetna of WY Medicare $20.79
Rate for Payer: Altius Auto/Workers Compensation $30.24
Rate for Payer: Altius Commercial $30.24
Rate for Payer: Beech Street Commercial $30.87
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.86
Rate for Payer: Cash Price $22.05
Rate for Payer: ChoiceCare Network Commercial $30.56
Rate for Payer: Cigna of WY Commercial $30.87
Rate for Payer: Entrust Commercial $29.92
Rate for Payer: First Choice Health Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.27
Rate for Payer: HealthUtah PPO $31.50
Rate for Payer: Idaho Integrated Healthcare Commercial $30.56
Rate for Payer: Multiplan Medicare/VA $17.36
Rate for Payer: One Health Plan of WY PPO $30.87
Rate for Payer: PacificSource Commercial $28.35
Rate for Payer: PHCS PPO $30.87
Rate for Payer: Three Rivers PPO $23.62
Rate for Payer: TriWest Veterans Administration $18.27
Rate for Payer: United Healthcare Commercial $27.40
Rate for Payer: United Healthcare Medicare $18.27
Rate for Payer: WINHealth Partners Commercial $30.87
Rate for Payer: Wise Provider Network Commercial $29.92
Service Code NDC 5515023510
Hospital Revenue Code 250
Min. Negotiated Rate $19.75
Max. Negotiated Rate $31.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.87
Rate for Payer: Altius Auto/Workers Compensation $30.24
Rate for Payer: Altius Commercial $30.24
Rate for Payer: Beech Street Commercial $30.87
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.86
Rate for Payer: Cash Price $22.05
Rate for Payer: ChoiceCare Network Commercial $30.56
Rate for Payer: Cigna of WY Commercial $30.87
Rate for Payer: Entrust Commercial $29.92
Rate for Payer: First Choice Health Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $20.79
Rate for Payer: HealthUtah PPO $31.50
Rate for Payer: Idaho Integrated Healthcare Commercial $30.56
Rate for Payer: Multiplan Medicare/VA $19.75
Rate for Payer: One Health Plan of WY PPO $30.87
Rate for Payer: PacificSource Commercial $28.35
Rate for Payer: PHCS PPO $30.87
Rate for Payer: Three Rivers PPO $23.62
Rate for Payer: TriWest Veterans Administration $20.79
Rate for Payer: United Healthcare Commercial $27.40
Rate for Payer: United Healthcare Medicare $20.79
Rate for Payer: WINHealth Partners Commercial $29.92
Rate for Payer: Wise Provider Network Commercial $29.92
Service Code NDC 5515023510
Hospital Revenue Code 250
Min. Negotiated Rate $17.36
Max. Negotiated Rate $31.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $30.87
Rate for Payer: Aetna of WY Medicare $20.79
Rate for Payer: Altius Auto/Workers Compensation $30.24
Rate for Payer: Altius Commercial $30.24
Rate for Payer: Beech Street Commercial $30.87
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $25.86
Rate for Payer: Cash Price $22.05
Rate for Payer: ChoiceCare Network Commercial $30.56
Rate for Payer: Cigna of WY Commercial $30.87
Rate for Payer: Entrust Commercial $29.92
Rate for Payer: First Choice Health Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Commercial $29.92
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.27
Rate for Payer: HealthUtah PPO $31.50
Rate for Payer: Idaho Integrated Healthcare Commercial $30.56
Rate for Payer: Multiplan Medicare/VA $17.36
Rate for Payer: One Health Plan of WY PPO $30.87
Rate for Payer: PacificSource Commercial $28.35
Rate for Payer: PHCS PPO $30.87
Rate for Payer: Three Rivers PPO $23.62
Rate for Payer: TriWest Veterans Administration $18.27
Rate for Payer: United Healthcare Commercial $27.40
Rate for Payer: United Healthcare Medicare $18.27
Rate for Payer: WINHealth Partners Commercial $30.87
Rate for Payer: Wise Provider Network Commercial $29.92
Service Code HCPCS J3380
Hospital Revenue Code 636
Min. Negotiated Rate $7,698.95
Max. Negotiated Rate $12,279.03
Rate for Payer: Aetna of WY Commercial/Medical Rental $12,033.45
Rate for Payer: Altius Auto/Workers Compensation $11,787.87
Rate for Payer: Altius Commercial $11,787.87
Rate for Payer: Beech Street Commercial $12,033.45
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $10,081.08
Rate for Payer: Cash Price $8,595.32
Rate for Payer: ChoiceCare Network Commercial $11,910.66
Rate for Payer: Cigna of WY Commercial $12,033.45
Rate for Payer: Entrust Commercial $11,665.08
Rate for Payer: First Choice Health Commercial $11,665.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $11,665.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8,104.16
Rate for Payer: HealthUtah PPO $12,279.03
Rate for Payer: Idaho Integrated Healthcare Commercial $11,910.66
Rate for Payer: Multiplan Medicare/VA $7,698.95
Rate for Payer: One Health Plan of WY PPO $12,033.45
Rate for Payer: PacificSource Commercial $11,051.13
Rate for Payer: PHCS PPO $12,033.45
Rate for Payer: Three Rivers PPO $9,209.27
Rate for Payer: TriWest Veterans Administration $8,104.16
Rate for Payer: United Healthcare Commercial $10,682.76
Rate for Payer: United Healthcare Medicare $8,104.16
Rate for Payer: WINHealth Partners Commercial $11,665.08
Rate for Payer: Wise Provider Network Commercial $11,665.08
Service Code HCPCS J3380
Hospital Revenue Code 636
Min. Negotiated Rate $6,765.75
Max. Negotiated Rate $12,279.03
Rate for Payer: Aetna of WY Commercial/Medical Rental $12,033.45
Rate for Payer: Aetna of WY Medicare $8,104.16
Rate for Payer: Altius Auto/Workers Compensation $11,787.87
Rate for Payer: Altius Commercial $11,787.87
Rate for Payer: Beech Street Commercial $12,033.45
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $10,081.08
Rate for Payer: Cash Price $8,595.32
Rate for Payer: ChoiceCare Network Commercial $11,910.66
Rate for Payer: Cigna of WY Commercial $12,033.45
Rate for Payer: Entrust Commercial $11,665.08
Rate for Payer: First Choice Health Commercial $11,665.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $11,665.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $7,121.84
Rate for Payer: HealthUtah PPO $12,279.03
Rate for Payer: Idaho Integrated Healthcare Commercial $11,910.66
Rate for Payer: Multiplan Medicare/VA $6,765.75
Rate for Payer: One Health Plan of WY PPO $12,033.45
Rate for Payer: PacificSource Commercial $11,051.13
Rate for Payer: PHCS PPO $12,033.45
Rate for Payer: Three Rivers PPO $9,209.27
Rate for Payer: TriWest Veterans Administration $7,121.84
Rate for Payer: United Healthcare Commercial $10,682.76
Rate for Payer: United Healthcare Medicare $7,121.84
Rate for Payer: WINHealth Partners Commercial $12,033.45
Rate for Payer: Wise Provider Network Commercial $11,665.08
Service Code HCPCS 36425
Hospital Charge Code 36425
Min. Negotiated Rate $31.76
Max. Negotiated Rate $207.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $202.86
Rate for Payer: Aetna of WY Medicare $37.37
Rate for Payer: Beech Street Commercial $196.65
Rate for Payer: Cash Price $144.90
Rate for Payer: Cash Price $144.90
Rate for Payer: ChoiceCare Network Commercial $200.79
Rate for Payer: Cigna of WY Commercial $202.86
Rate for Payer: First Choice Health Commercial $186.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $196.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $37.37
Rate for Payer: HealthUtah PPO $207.00
Rate for Payer: Idaho Integrated Healthcare Commercial $200.79
Rate for Payer: Multiplan Medicare/VA $31.76
Rate for Payer: One Health Plan of WY PPO $202.86
Rate for Payer: PacificSource Commercial $186.30
Rate for Payer: PHCS PPO $196.65
Rate for Payer: Three Rivers PPO $155.25
Rate for Payer: TriWest Veterans Administration $37.37
Rate for Payer: United Healthcare Commercial $180.09
Rate for Payer: United Healthcare Medicare $37.37
Rate for Payer: WINHealth Partners Commercial $175.95
Service Code NDC 6808471301
Hospital Revenue Code 250
Min. Negotiated Rate $1.55
Max. Negotiated Rate $2.48
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.43
Rate for Payer: Altius Auto/Workers Compensation $2.38
Rate for Payer: Altius Commercial $2.38
Rate for Payer: Beech Street Commercial $2.43
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.04
Rate for Payer: Cash Price $1.74
Rate for Payer: ChoiceCare Network Commercial $2.41
Rate for Payer: Cigna of WY Commercial $2.43
Rate for Payer: Entrust Commercial $2.36
Rate for Payer: First Choice Health Commercial $2.36
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.36
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.64
Rate for Payer: HealthUtah PPO $2.48
Rate for Payer: Idaho Integrated Healthcare Commercial $2.41
Rate for Payer: Multiplan Medicare/VA $1.55
Rate for Payer: One Health Plan of WY PPO $2.43
Rate for Payer: PacificSource Commercial $2.23
Rate for Payer: PHCS PPO $2.43
Rate for Payer: Three Rivers PPO $1.86
Rate for Payer: TriWest Veterans Administration $1.64
Rate for Payer: United Healthcare Commercial $2.16
Rate for Payer: United Healthcare Medicare $1.64
Rate for Payer: WINHealth Partners Commercial $2.36
Rate for Payer: Wise Provider Network Commercial $2.36