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Service Code NDC 6808471301
Hospital Revenue Code 250
Min. Negotiated Rate $1.37
Max. Negotiated Rate $2.48
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.43
Rate for Payer: Aetna of WY Medicare $1.64
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 $1.44
Rate for Payer: HealthUtah PPO $2.48
Rate for Payer: Idaho Integrated Healthcare Commercial $2.41
Rate for Payer: Multiplan Medicare/VA $1.37
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 $1.44
Rate for Payer: United Healthcare Commercial $2.16
Rate for Payer: United Healthcare Medicare $1.44
Rate for Payer: WINHealth Partners Commercial $2.43
Rate for Payer: Wise Provider Network Commercial $2.36
Service Code NDC 6808471311
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
Service Code NDC 6808471311
Hospital Revenue Code 250
Min. Negotiated Rate $1.37
Max. Negotiated Rate $2.48
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.43
Rate for Payer: Aetna of WY Medicare $1.64
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 $1.44
Rate for Payer: HealthUtah PPO $2.48
Rate for Payer: Idaho Integrated Healthcare Commercial $2.41
Rate for Payer: Multiplan Medicare/VA $1.37
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 $1.44
Rate for Payer: United Healthcare Commercial $2.16
Rate for Payer: United Healthcare Medicare $1.44
Rate for Payer: WINHealth Partners Commercial $2.43
Rate for Payer: Wise Provider Network Commercial $2.36
Service Code NDC 6808470901
Hospital Revenue Code 250
Min. Negotiated Rate $1.37
Max. Negotiated Rate $2.19
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.15
Rate for Payer: Altius Auto/Workers Compensation $2.10
Rate for Payer: Altius Commercial $2.10
Rate for Payer: Beech Street Commercial $2.15
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.80
Rate for Payer: Cash Price $1.53
Rate for Payer: ChoiceCare Network Commercial $2.12
Rate for Payer: Cigna of WY Commercial $2.15
Rate for Payer: Entrust Commercial $2.08
Rate for Payer: First Choice Health Commercial $2.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.45
Rate for Payer: HealthUtah PPO $2.19
Rate for Payer: Idaho Integrated Healthcare Commercial $2.12
Rate for Payer: Multiplan Medicare/VA $1.37
Rate for Payer: One Health Plan of WY PPO $2.15
Rate for Payer: PacificSource Commercial $1.97
Rate for Payer: PHCS PPO $2.15
Rate for Payer: Three Rivers PPO $1.64
Rate for Payer: TriWest Veterans Administration $1.45
Rate for Payer: United Healthcare Commercial $1.91
Rate for Payer: United Healthcare Medicare $1.45
Rate for Payer: WINHealth Partners Commercial $2.08
Rate for Payer: Wise Provider Network Commercial $2.08
Service Code NDC 6808470901
Hospital Revenue Code 250
Min. Negotiated Rate $1.21
Max. Negotiated Rate $2.19
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.15
Rate for Payer: Aetna of WY Medicare $1.45
Rate for Payer: Altius Auto/Workers Compensation $2.10
Rate for Payer: Altius Commercial $2.10
Rate for Payer: Beech Street Commercial $2.15
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.80
Rate for Payer: Cash Price $1.53
Rate for Payer: ChoiceCare Network Commercial $2.12
Rate for Payer: Cigna of WY Commercial $2.15
Rate for Payer: Entrust Commercial $2.08
Rate for Payer: First Choice Health Commercial $2.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.27
Rate for Payer: HealthUtah PPO $2.19
Rate for Payer: Idaho Integrated Healthcare Commercial $2.12
Rate for Payer: Multiplan Medicare/VA $1.21
Rate for Payer: One Health Plan of WY PPO $2.15
Rate for Payer: PacificSource Commercial $1.97
Rate for Payer: PHCS PPO $2.15
Rate for Payer: Three Rivers PPO $1.64
Rate for Payer: TriWest Veterans Administration $1.27
Rate for Payer: United Healthcare Commercial $1.91
Rate for Payer: United Healthcare Medicare $1.27
Rate for Payer: WINHealth Partners Commercial $2.15
Rate for Payer: Wise Provider Network Commercial $2.08
Service Code NDC 6808470911
Hospital Revenue Code 250
Min. Negotiated Rate $1.37
Max. Negotiated Rate $2.19
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.15
Rate for Payer: Altius Auto/Workers Compensation $2.10
Rate for Payer: Altius Commercial $2.10
Rate for Payer: Beech Street Commercial $2.15
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.80
Rate for Payer: Cash Price $1.53
Rate for Payer: ChoiceCare Network Commercial $2.12
Rate for Payer: Cigna of WY Commercial $2.15
Rate for Payer: Entrust Commercial $2.08
Rate for Payer: First Choice Health Commercial $2.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.45
Rate for Payer: HealthUtah PPO $2.19
Rate for Payer: Idaho Integrated Healthcare Commercial $2.12
Rate for Payer: Multiplan Medicare/VA $1.37
Rate for Payer: One Health Plan of WY PPO $2.15
Rate for Payer: PacificSource Commercial $1.97
Rate for Payer: PHCS PPO $2.15
Rate for Payer: Three Rivers PPO $1.64
Rate for Payer: TriWest Veterans Administration $1.45
Rate for Payer: United Healthcare Commercial $1.91
Rate for Payer: United Healthcare Medicare $1.45
Rate for Payer: WINHealth Partners Commercial $2.08
Rate for Payer: Wise Provider Network Commercial $2.08
Service Code NDC 6808470911
Hospital Revenue Code 250
Min. Negotiated Rate $1.21
Max. Negotiated Rate $2.19
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.15
Rate for Payer: Aetna of WY Medicare $1.45
Rate for Payer: Altius Auto/Workers Compensation $2.10
Rate for Payer: Altius Commercial $2.10
Rate for Payer: Beech Street Commercial $2.15
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.80
Rate for Payer: Cash Price $1.53
Rate for Payer: ChoiceCare Network Commercial $2.12
Rate for Payer: Cigna of WY Commercial $2.15
Rate for Payer: Entrust Commercial $2.08
Rate for Payer: First Choice Health Commercial $2.08
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.08
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.27
Rate for Payer: HealthUtah PPO $2.19
Rate for Payer: Idaho Integrated Healthcare Commercial $2.12
Rate for Payer: Multiplan Medicare/VA $1.21
Rate for Payer: One Health Plan of WY PPO $2.15
Rate for Payer: PacificSource Commercial $1.97
Rate for Payer: PHCS PPO $2.15
Rate for Payer: Three Rivers PPO $1.64
Rate for Payer: TriWest Veterans Administration $1.27
Rate for Payer: United Healthcare Commercial $1.91
Rate for Payer: United Healthcare Medicare $1.27
Rate for Payer: WINHealth Partners Commercial $2.15
Rate for Payer: Wise Provider Network Commercial $2.08
Service Code HCPCS 69424
Hospital Charge Code 69424
Min. Negotiated Rate $49.93
Max. Negotiated Rate $446.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $437.08
Rate for Payer: Aetna of WY Medicare $58.74
Rate for Payer: Beech Street Commercial $423.70
Rate for Payer: Cash Price $312.20
Rate for Payer: Cash Price $312.20
Rate for Payer: ChoiceCare Network Commercial $432.62
Rate for Payer: Cigna of WY Commercial $437.08
Rate for Payer: First Choice Health Commercial $401.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $423.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.74
Rate for Payer: HealthUtah PPO $446.00
Rate for Payer: Idaho Integrated Healthcare Commercial $432.62
Rate for Payer: Multiplan Medicare/VA $49.93
Rate for Payer: One Health Plan of WY PPO $437.08
Rate for Payer: PacificSource Commercial $401.40
Rate for Payer: PHCS PPO $423.70
Rate for Payer: Three Rivers PPO $334.50
Rate for Payer: TriWest Veterans Administration $58.74
Rate for Payer: United Healthcare Commercial $388.02
Rate for Payer: United Healthcare Medicare $58.74
Rate for Payer: WINHealth Partners Commercial $379.10
Service Code HCPCS 69424 50
Hospital Charge Code 69424
Min. Negotiated Rate $49.93
Max. Negotiated Rate $892.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $874.16
Rate for Payer: Aetna of WY Medicare $58.74
Rate for Payer: Beech Street Commercial $847.40
Rate for Payer: Cash Price $624.40
Rate for Payer: Cash Price $624.40
Rate for Payer: ChoiceCare Network Commercial $865.24
Rate for Payer: Cigna of WY Commercial $874.16
Rate for Payer: First Choice Health Commercial $802.80
Rate for Payer: Government Employees Health Association (GEHA) Commercial $847.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $58.74
Rate for Payer: HealthUtah PPO $892.00
Rate for Payer: Idaho Integrated Healthcare Commercial $865.24
Rate for Payer: Multiplan Medicare/VA $49.93
Rate for Payer: One Health Plan of WY PPO $874.16
Rate for Payer: PacificSource Commercial $802.80
Rate for Payer: PHCS PPO $847.40
Rate for Payer: Three Rivers PPO $669.00
Rate for Payer: TriWest Veterans Administration $58.74
Rate for Payer: United Healthcare Commercial $776.04
Rate for Payer: United Healthcare Medicare $58.74
Rate for Payer: WINHealth Partners Commercial $758.20
Service Code NDC 7071016431
Hospital Revenue Code 250
Min. Negotiated Rate $21.16
Max. Negotiated Rate $33.75
Rate for Payer: Aetna of WY Commercial/Medical Rental $33.08
Rate for Payer: Altius Auto/Workers Compensation $32.40
Rate for Payer: Altius Commercial $32.40
Rate for Payer: Beech Street Commercial $33.08
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $27.71
Rate for Payer: Cash Price $23.62
Rate for Payer: ChoiceCare Network Commercial $32.74
Rate for Payer: Cigna of WY Commercial $33.08
Rate for Payer: Entrust Commercial $32.06
Rate for Payer: First Choice Health Commercial $32.06
Rate for Payer: Government Employees Health Association (GEHA) Commercial $32.06
Rate for Payer: Government Employees Health Association (GEHA) Medicare $22.28
Rate for Payer: HealthUtah PPO $33.75
Rate for Payer: Idaho Integrated Healthcare Commercial $32.74
Rate for Payer: Multiplan Medicare/VA $21.16
Rate for Payer: One Health Plan of WY PPO $33.08
Rate for Payer: PacificSource Commercial $30.38
Rate for Payer: PHCS PPO $33.08
Rate for Payer: Three Rivers PPO $25.31
Rate for Payer: TriWest Veterans Administration $22.28
Rate for Payer: United Healthcare Commercial $29.36
Rate for Payer: United Healthcare Medicare $22.28
Rate for Payer: WINHealth Partners Commercial $32.06
Rate for Payer: Wise Provider Network Commercial $32.06
Service Code NDC 7071016431
Hospital Revenue Code 250
Min. Negotiated Rate $18.60
Max. Negotiated Rate $33.75
Rate for Payer: Aetna of WY Commercial/Medical Rental $33.08
Rate for Payer: Aetna of WY Medicare $22.28
Rate for Payer: Altius Auto/Workers Compensation $32.40
Rate for Payer: Altius Commercial $32.40
Rate for Payer: Beech Street Commercial $33.08
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $27.71
Rate for Payer: Cash Price $23.62
Rate for Payer: ChoiceCare Network Commercial $32.74
Rate for Payer: Cigna of WY Commercial $33.08
Rate for Payer: Entrust Commercial $32.06
Rate for Payer: First Choice Health Commercial $32.06
Rate for Payer: Government Employees Health Association (GEHA) Commercial $32.06
Rate for Payer: Government Employees Health Association (GEHA) Medicare $19.58
Rate for Payer: HealthUtah PPO $33.75
Rate for Payer: Idaho Integrated Healthcare Commercial $32.74
Rate for Payer: Multiplan Medicare/VA $18.60
Rate for Payer: One Health Plan of WY PPO $33.08
Rate for Payer: PacificSource Commercial $30.38
Rate for Payer: PHCS PPO $33.08
Rate for Payer: Three Rivers PPO $25.31
Rate for Payer: TriWest Veterans Administration $19.58
Rate for Payer: United Healthcare Commercial $29.36
Rate for Payer: United Healthcare Medicare $19.58
Rate for Payer: WINHealth Partners Commercial $33.08
Rate for Payer: Wise Provider Network Commercial $32.06
Service Code NDC 6846229201
Hospital Revenue Code 250
Min. Negotiated Rate $1.51
Max. Negotiated Rate $2.41
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.36
Rate for Payer: Altius Auto/Workers Compensation $2.31
Rate for Payer: Altius Commercial $2.31
Rate for Payer: Beech Street Commercial $2.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.98
Rate for Payer: Cash Price $1.69
Rate for Payer: ChoiceCare Network Commercial $2.34
Rate for Payer: Cigna of WY Commercial $2.36
Rate for Payer: Entrust Commercial $2.29
Rate for Payer: First Choice Health Commercial $2.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.59
Rate for Payer: HealthUtah PPO $2.41
Rate for Payer: Idaho Integrated Healthcare Commercial $2.34
Rate for Payer: Multiplan Medicare/VA $1.51
Rate for Payer: One Health Plan of WY PPO $2.36
Rate for Payer: PacificSource Commercial $2.17
Rate for Payer: PHCS PPO $2.36
Rate for Payer: Three Rivers PPO $1.81
Rate for Payer: TriWest Veterans Administration $1.59
Rate for Payer: United Healthcare Commercial $2.10
Rate for Payer: United Healthcare Medicare $1.59
Rate for Payer: WINHealth Partners Commercial $2.29
Rate for Payer: Wise Provider Network Commercial $2.29
Service Code NDC 6846229201
Hospital Revenue Code 250
Min. Negotiated Rate $1.33
Max. Negotiated Rate $2.41
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.36
Rate for Payer: Aetna of WY Medicare $1.59
Rate for Payer: Altius Auto/Workers Compensation $2.31
Rate for Payer: Altius Commercial $2.31
Rate for Payer: Beech Street Commercial $2.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.98
Rate for Payer: Cash Price $1.69
Rate for Payer: ChoiceCare Network Commercial $2.34
Rate for Payer: Cigna of WY Commercial $2.36
Rate for Payer: Entrust Commercial $2.29
Rate for Payer: First Choice Health Commercial $2.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.40
Rate for Payer: HealthUtah PPO $2.41
Rate for Payer: Idaho Integrated Healthcare Commercial $2.34
Rate for Payer: Multiplan Medicare/VA $1.33
Rate for Payer: One Health Plan of WY PPO $2.36
Rate for Payer: PacificSource Commercial $2.17
Rate for Payer: PHCS PPO $2.36
Rate for Payer: Three Rivers PPO $1.81
Rate for Payer: TriWest Veterans Administration $1.40
Rate for Payer: United Healthcare Commercial $2.10
Rate for Payer: United Healthcare Medicare $1.40
Rate for Payer: WINHealth Partners Commercial $2.36
Rate for Payer: Wise Provider Network Commercial $2.29
Service Code NDC 7583432001
Hospital Revenue Code 250
Min. Negotiated Rate $1.51
Max. Negotiated Rate $2.41
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.36
Rate for Payer: Altius Auto/Workers Compensation $2.31
Rate for Payer: Altius Commercial $2.31
Rate for Payer: Beech Street Commercial $2.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.98
Rate for Payer: Cash Price $1.69
Rate for Payer: ChoiceCare Network Commercial $2.34
Rate for Payer: Cigna of WY Commercial $2.36
Rate for Payer: Entrust Commercial $2.29
Rate for Payer: First Choice Health Commercial $2.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.59
Rate for Payer: HealthUtah PPO $2.41
Rate for Payer: Idaho Integrated Healthcare Commercial $2.34
Rate for Payer: Multiplan Medicare/VA $1.51
Rate for Payer: One Health Plan of WY PPO $2.36
Rate for Payer: PacificSource Commercial $2.17
Rate for Payer: PHCS PPO $2.36
Rate for Payer: Three Rivers PPO $1.81
Rate for Payer: TriWest Veterans Administration $1.59
Rate for Payer: United Healthcare Commercial $2.10
Rate for Payer: United Healthcare Medicare $1.59
Rate for Payer: WINHealth Partners Commercial $2.29
Rate for Payer: Wise Provider Network Commercial $2.29
Service Code NDC 7583432001
Hospital Revenue Code 250
Min. Negotiated Rate $1.33
Max. Negotiated Rate $2.41
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.36
Rate for Payer: Aetna of WY Medicare $1.59
Rate for Payer: Altius Auto/Workers Compensation $2.31
Rate for Payer: Altius Commercial $2.31
Rate for Payer: Beech Street Commercial $2.36
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.98
Rate for Payer: Cash Price $1.69
Rate for Payer: ChoiceCare Network Commercial $2.34
Rate for Payer: Cigna of WY Commercial $2.36
Rate for Payer: Entrust Commercial $2.29
Rate for Payer: First Choice Health Commercial $2.29
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.29
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.40
Rate for Payer: HealthUtah PPO $2.41
Rate for Payer: Idaho Integrated Healthcare Commercial $2.34
Rate for Payer: Multiplan Medicare/VA $1.33
Rate for Payer: One Health Plan of WY PPO $2.36
Rate for Payer: PacificSource Commercial $2.17
Rate for Payer: PHCS PPO $2.36
Rate for Payer: Three Rivers PPO $1.81
Rate for Payer: TriWest Veterans Administration $1.40
Rate for Payer: United Healthcare Commercial $2.10
Rate for Payer: United Healthcare Medicare $1.40
Rate for Payer: WINHealth Partners Commercial $2.36
Rate for Payer: Wise Provider Network Commercial $2.29
Service Code HCPCS 63081
Hospital Charge Code 63081
Min. Negotiated Rate $1,422.98
Max. Negotiated Rate $5,974.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,854.52
Rate for Payer: Aetna of WY Medicare $1,674.09
Rate for Payer: Beech Street Commercial $5,675.30
Rate for Payer: Cash Price $4,181.80
Rate for Payer: Cash Price $4,181.80
Rate for Payer: ChoiceCare Network Commercial $5,794.78
Rate for Payer: Cigna of WY Commercial $5,854.52
Rate for Payer: First Choice Health Commercial $5,376.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,675.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,674.09
Rate for Payer: HealthUtah PPO $5,974.00
Rate for Payer: Idaho Integrated Healthcare Commercial $5,794.78
Rate for Payer: Multiplan Medicare/VA $1,422.98
Rate for Payer: One Health Plan of WY PPO $5,854.52
Rate for Payer: PacificSource Commercial $5,376.60
Rate for Payer: PHCS PPO $5,675.30
Rate for Payer: Three Rivers PPO $4,480.50
Rate for Payer: TriWest Veterans Administration $1,674.09
Rate for Payer: United Healthcare Commercial $5,197.38
Rate for Payer: United Healthcare Medicare $1,674.09
Rate for Payer: WINHealth Partners Commercial $5,077.90
Service Code HCPCS J9370
Hospital Revenue Code 636
Min. Negotiated Rate $34.45
Max. Negotiated Rate $54.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $53.84
Rate for Payer: Altius Auto/Workers Compensation $52.74
Rate for Payer: Altius Commercial $52.74
Rate for Payer: Beech Street Commercial $53.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $45.11
Rate for Payer: Cash Price $38.46
Rate for Payer: ChoiceCare Network Commercial $53.29
Rate for Payer: Cigna of WY Commercial $53.84
Rate for Payer: Entrust Commercial $52.19
Rate for Payer: First Choice Health Commercial $52.19
Rate for Payer: Government Employees Health Association (GEHA) Commercial $52.19
Rate for Payer: Government Employees Health Association (GEHA) Medicare $36.26
Rate for Payer: HealthUtah PPO $54.94
Rate for Payer: Idaho Integrated Healthcare Commercial $53.29
Rate for Payer: Multiplan Medicare/VA $34.45
Rate for Payer: One Health Plan of WY PPO $53.84
Rate for Payer: PacificSource Commercial $49.45
Rate for Payer: PHCS PPO $53.84
Rate for Payer: Three Rivers PPO $41.20
Rate for Payer: TriWest Veterans Administration $36.26
Rate for Payer: United Healthcare Commercial $47.80
Rate for Payer: United Healthcare Medicare $36.26
Rate for Payer: WINHealth Partners Commercial $52.19
Rate for Payer: Wise Provider Network Commercial $52.19
Service Code HCPCS J9370
Hospital Revenue Code 636
Min. Negotiated Rate $30.27
Max. Negotiated Rate $54.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $53.84
Rate for Payer: Aetna of WY Medicare $36.26
Rate for Payer: Altius Auto/Workers Compensation $52.74
Rate for Payer: Altius Commercial $52.74
Rate for Payer: Beech Street Commercial $53.84
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $45.11
Rate for Payer: Cash Price $38.46
Rate for Payer: ChoiceCare Network Commercial $53.29
Rate for Payer: Cigna of WY Commercial $53.84
Rate for Payer: Entrust Commercial $52.19
Rate for Payer: First Choice Health Commercial $52.19
Rate for Payer: Government Employees Health Association (GEHA) Commercial $52.19
Rate for Payer: Government Employees Health Association (GEHA) Medicare $31.87
Rate for Payer: HealthUtah PPO $54.94
Rate for Payer: Idaho Integrated Healthcare Commercial $53.29
Rate for Payer: Multiplan Medicare/VA $30.27
Rate for Payer: One Health Plan of WY PPO $53.84
Rate for Payer: PacificSource Commercial $49.45
Rate for Payer: PHCS PPO $53.84
Rate for Payer: Three Rivers PPO $41.20
Rate for Payer: TriWest Veterans Administration $31.87
Rate for Payer: United Healthcare Commercial $47.80
Rate for Payer: United Healthcare Medicare $31.87
Rate for Payer: WINHealth Partners Commercial $53.84
Rate for Payer: Wise Provider Network Commercial $52.19
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $47.36
Max. Negotiated Rate $85.95
Rate for Payer: Aetna of WY Commercial/Medical Rental $84.23
Rate for Payer: Aetna of WY Medicare $56.73
Rate for Payer: Altius Auto/Workers Compensation $82.51
Rate for Payer: Altius Commercial $82.51
Rate for Payer: Beech Street Commercial $84.23
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $70.56
Rate for Payer: Cash Price $60.16
Rate for Payer: ChoiceCare Network Commercial $83.37
Rate for Payer: Cigna of WY Commercial $84.23
Rate for Payer: Entrust Commercial $81.65
Rate for Payer: First Choice Health Commercial $81.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $81.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $49.85
Rate for Payer: HealthUtah PPO $85.95
Rate for Payer: Idaho Integrated Healthcare Commercial $83.37
Rate for Payer: Multiplan Medicare/VA $47.36
Rate for Payer: One Health Plan of WY PPO $84.23
Rate for Payer: PacificSource Commercial $77.36
Rate for Payer: PHCS PPO $84.23
Rate for Payer: Three Rivers PPO $64.46
Rate for Payer: TriWest Veterans Administration $49.85
Rate for Payer: United Healthcare Commercial $74.78
Rate for Payer: United Healthcare Medicare $49.85
Rate for Payer: WINHealth Partners Commercial $84.23
Rate for Payer: Wise Provider Network Commercial $81.65
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $53.89
Max. Negotiated Rate $85.95
Rate for Payer: Aetna of WY Commercial/Medical Rental $84.23
Rate for Payer: Altius Auto/Workers Compensation $82.51
Rate for Payer: Altius Commercial $82.51
Rate for Payer: Beech Street Commercial $84.23
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $70.56
Rate for Payer: Cash Price $60.16
Rate for Payer: ChoiceCare Network Commercial $83.37
Rate for Payer: Cigna of WY Commercial $84.23
Rate for Payer: Entrust Commercial $81.65
Rate for Payer: First Choice Health Commercial $81.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $81.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $56.73
Rate for Payer: HealthUtah PPO $85.95
Rate for Payer: Idaho Integrated Healthcare Commercial $83.37
Rate for Payer: Multiplan Medicare/VA $53.89
Rate for Payer: One Health Plan of WY PPO $84.23
Rate for Payer: PacificSource Commercial $77.36
Rate for Payer: PHCS PPO $84.23
Rate for Payer: Three Rivers PPO $64.46
Rate for Payer: TriWest Veterans Administration $56.73
Rate for Payer: United Healthcare Commercial $74.78
Rate for Payer: United Healthcare Medicare $56.73
Rate for Payer: WINHealth Partners Commercial $81.65
Rate for Payer: Wise Provider Network Commercial $81.65
Service Code HCPCS 94150 26
Hospital Charge Code 94150
Min. Negotiated Rate $29.25
Max. Negotiated Rate $39.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $38.22
Rate for Payer: Beech Street Commercial $37.05
Rate for Payer: Cash Price $27.30
Rate for Payer: ChoiceCare Network Commercial $37.83
Rate for Payer: Cigna of WY Commercial $38.22
Rate for Payer: First Choice Health Commercial $35.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $37.05
Rate for Payer: HealthUtah PPO $39.00
Rate for Payer: Idaho Integrated Healthcare Commercial $37.83
Rate for Payer: One Health Plan of WY PPO $38.22
Rate for Payer: PacificSource Commercial $35.10
Rate for Payer: PHCS PPO $37.05
Rate for Payer: Three Rivers PPO $29.25
Rate for Payer: United Healthcare Commercial $33.93
Rate for Payer: WINHealth Partners Commercial $37.05
Service Code HCPCS 94150
Hospital Charge Code 94150
Min. Negotiated Rate $68.25
Max. Negotiated Rate $91.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $89.18
Rate for Payer: Beech Street Commercial $86.45
Rate for Payer: Cash Price $63.70
Rate for Payer: ChoiceCare Network Commercial $88.27
Rate for Payer: Cigna of WY Commercial $89.18
Rate for Payer: First Choice Health Commercial $81.90
Rate for Payer: Government Employees Health Association (GEHA) Commercial $86.45
Rate for Payer: HealthUtah PPO $91.00
Rate for Payer: Idaho Integrated Healthcare Commercial $88.27
Rate for Payer: One Health Plan of WY PPO $89.18
Rate for Payer: PacificSource Commercial $81.90
Rate for Payer: PHCS PPO $86.45
Rate for Payer: Three Rivers PPO $68.25
Rate for Payer: United Healthcare Commercial $79.17
Rate for Payer: WINHealth Partners Commercial $86.45
Service Code NDC 0904208560
Hospital Revenue Code 250
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.17
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.17
Rate for Payer: Altius Auto/Workers Compensation $0.16
Rate for Payer: Altius Commercial $0.16
Rate for Payer: Beech Street Commercial $0.17
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.14
Rate for Payer: Cash Price $0.12
Rate for Payer: ChoiceCare Network Commercial $0.16
Rate for Payer: Cigna of WY Commercial $0.17
Rate for Payer: Entrust Commercial $0.16
Rate for Payer: First Choice Health Commercial $0.16
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.16
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.11
Rate for Payer: HealthUtah PPO $0.17
Rate for Payer: Idaho Integrated Healthcare Commercial $0.16
Rate for Payer: Multiplan Medicare/VA $0.11
Rate for Payer: One Health Plan of WY PPO $0.17
Rate for Payer: PacificSource Commercial $0.15
Rate for Payer: PHCS PPO $0.17
Rate for Payer: Three Rivers PPO $0.13
Rate for Payer: TriWest Veterans Administration $0.11
Rate for Payer: United Healthcare Commercial $0.15
Rate for Payer: United Healthcare Medicare $0.11
Rate for Payer: WINHealth Partners Commercial $0.16
Rate for Payer: Wise Provider Network Commercial $0.16
Service Code NDC 0904208560
Hospital Revenue Code 250
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.17
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.17
Rate for Payer: Aetna of WY Medicare $0.11
Rate for Payer: Altius Auto/Workers Compensation $0.16
Rate for Payer: Altius Commercial $0.16
Rate for Payer: Beech Street Commercial $0.17
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.14
Rate for Payer: Cash Price $0.12
Rate for Payer: ChoiceCare Network Commercial $0.16
Rate for Payer: Cigna of WY Commercial $0.17
Rate for Payer: Entrust Commercial $0.16
Rate for Payer: First Choice Health Commercial $0.16
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.16
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.10
Rate for Payer: HealthUtah PPO $0.17
Rate for Payer: Idaho Integrated Healthcare Commercial $0.16
Rate for Payer: Multiplan Medicare/VA $0.09
Rate for Payer: One Health Plan of WY PPO $0.17
Rate for Payer: PacificSource Commercial $0.15
Rate for Payer: PHCS PPO $0.17
Rate for Payer: Three Rivers PPO $0.13
Rate for Payer: TriWest Veterans Administration $0.10
Rate for Payer: United Healthcare Commercial $0.15
Rate for Payer: United Healthcare Medicare $0.10
Rate for Payer: WINHealth Partners Commercial $0.17
Rate for Payer: Wise Provider Network Commercial $0.16
Service Code NDC 7019902611
Hospital Revenue Code 250
Min. Negotiated Rate $234.74
Max. Negotiated Rate $374.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $366.89
Rate for Payer: Altius Auto/Workers Compensation $359.40
Rate for Payer: Altius Commercial $359.40
Rate for Payer: Beech Street Commercial $366.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $307.37
Rate for Payer: Cash Price $262.06
Rate for Payer: ChoiceCare Network Commercial $363.15
Rate for Payer: Cigna of WY Commercial $366.89
Rate for Payer: Entrust Commercial $355.66
Rate for Payer: First Choice Health Commercial $355.66
Rate for Payer: Government Employees Health Association (GEHA) Commercial $355.66
Rate for Payer: Government Employees Health Association (GEHA) Medicare $247.09
Rate for Payer: HealthUtah PPO $374.38
Rate for Payer: Idaho Integrated Healthcare Commercial $363.15
Rate for Payer: Multiplan Medicare/VA $234.74
Rate for Payer: One Health Plan of WY PPO $366.89
Rate for Payer: PacificSource Commercial $336.94
Rate for Payer: PHCS PPO $366.89
Rate for Payer: Three Rivers PPO $280.78
Rate for Payer: TriWest Veterans Administration $247.09
Rate for Payer: United Healthcare Commercial $325.71
Rate for Payer: United Healthcare Medicare $247.09
Rate for Payer: WINHealth Partners Commercial $355.66
Rate for Payer: Wise Provider Network Commercial $355.66