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Service Code HCPCS L3808
Hospital Charge Code L3808
Min. Negotiated Rate $333.94
Max. Negotiated Rate $539.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $528.22
Rate for Payer: Aetna of WY Medicare $392.87
Rate for Payer: Beech Street Commercial $512.05
Rate for Payer: Cash Price $377.30
Rate for Payer: Cash Price $377.30
Rate for Payer: ChoiceCare Network Commercial $522.83
Rate for Payer: Cigna of WY Commercial $528.22
Rate for Payer: First Choice Health Commercial $485.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $512.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $392.87
Rate for Payer: HealthUtah PPO $539.00
Rate for Payer: Idaho Integrated Healthcare Commercial $522.83
Rate for Payer: Multiplan Medicare/VA $333.94
Rate for Payer: One Health Plan of WY PPO $528.22
Rate for Payer: PacificSource Commercial $485.10
Rate for Payer: PHCS PPO $512.05
Rate for Payer: Three Rivers PPO $404.25
Rate for Payer: TriWest Veterans Administration $392.87
Rate for Payer: United Healthcare Commercial $468.93
Rate for Payer: United Healthcare Medicare $392.87
Rate for Payer: WINHealth Partners Commercial $512.05
Service Code HCPCS L3807
Hospital Charge Code L3807
Min. Negotiated Rate $40.50
Max. Negotiated Rate $54.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $52.92
Rate for Payer: Beech Street Commercial $51.30
Rate for Payer: Cash Price $37.80
Rate for Payer: ChoiceCare Network Commercial $52.38
Rate for Payer: Cigna of WY Commercial $52.92
Rate for Payer: First Choice Health Commercial $48.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $51.30
Rate for Payer: HealthUtah PPO $54.00
Rate for Payer: Idaho Integrated Healthcare Commercial $52.38
Rate for Payer: One Health Plan of WY PPO $52.92
Rate for Payer: PacificSource Commercial $48.60
Rate for Payer: PHCS PPO $51.30
Rate for Payer: Three Rivers PPO $40.50
Rate for Payer: United Healthcare Commercial $46.98
Rate for Payer: WINHealth Partners Commercial $51.30
Service Code HCPCS L3809
Hospital Charge Code L3809
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 0023031204
Hospital Revenue Code 250
Min. Negotiated Rate $6.56
Max. Negotiated Rate $10.47
Rate for Payer: Aetna of WY Commercial/Medical Rental $10.26
Rate for Payer: Altius Auto/Workers Compensation $10.05
Rate for Payer: Altius Commercial $10.05
Rate for Payer: Beech Street Commercial $10.26
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $8.60
Rate for Payer: Cash Price $7.33
Rate for Payer: ChoiceCare Network Commercial $10.16
Rate for Payer: Cigna of WY Commercial $10.26
Rate for Payer: Entrust Commercial $9.95
Rate for Payer: First Choice Health Commercial $9.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $9.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $6.91
Rate for Payer: HealthUtah PPO $10.47
Rate for Payer: Idaho Integrated Healthcare Commercial $10.16
Rate for Payer: Multiplan Medicare/VA $6.56
Rate for Payer: One Health Plan of WY PPO $10.26
Rate for Payer: PacificSource Commercial $9.42
Rate for Payer: PHCS PPO $10.26
Rate for Payer: Three Rivers PPO $7.85
Rate for Payer: TriWest Veterans Administration $6.91
Rate for Payer: United Healthcare Commercial $9.11
Rate for Payer: United Healthcare Medicare $6.91
Rate for Payer: WINHealth Partners Commercial $9.95
Rate for Payer: Wise Provider Network Commercial $9.95
Service Code NDC 0023031204
Hospital Revenue Code 250
Min. Negotiated Rate $5.77
Max. Negotiated Rate $10.47
Rate for Payer: Aetna of WY Commercial/Medical Rental $10.26
Rate for Payer: Aetna of WY Medicare $6.91
Rate for Payer: Altius Auto/Workers Compensation $10.05
Rate for Payer: Altius Commercial $10.05
Rate for Payer: Beech Street Commercial $10.26
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $8.60
Rate for Payer: Cash Price $7.33
Rate for Payer: ChoiceCare Network Commercial $10.16
Rate for Payer: Cigna of WY Commercial $10.26
Rate for Payer: Entrust Commercial $9.95
Rate for Payer: First Choice Health Commercial $9.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $9.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $6.07
Rate for Payer: HealthUtah PPO $10.47
Rate for Payer: Idaho Integrated Healthcare Commercial $10.16
Rate for Payer: Multiplan Medicare/VA $5.77
Rate for Payer: One Health Plan of WY PPO $10.26
Rate for Payer: PacificSource Commercial $9.42
Rate for Payer: PHCS PPO $10.26
Rate for Payer: Three Rivers PPO $7.85
Rate for Payer: TriWest Veterans Administration $6.07
Rate for Payer: United Healthcare Commercial $9.11
Rate for Payer: United Healthcare Medicare $6.07
Rate for Payer: WINHealth Partners Commercial $10.26
Rate for Payer: Wise Provider Network Commercial $9.95
Service Code NDC 0023024004
Hospital Revenue Code 250
Min. Negotiated Rate $6.15
Max. Negotiated Rate $9.81
Rate for Payer: Aetna of WY Commercial/Medical Rental $9.61
Rate for Payer: Altius Auto/Workers Compensation $9.42
Rate for Payer: Altius Commercial $9.42
Rate for Payer: Beech Street Commercial $9.61
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $8.05
Rate for Payer: Cash Price $6.86
Rate for Payer: ChoiceCare Network Commercial $9.52
Rate for Payer: Cigna of WY Commercial $9.61
Rate for Payer: Entrust Commercial $9.32
Rate for Payer: First Choice Health Commercial $9.32
Rate for Payer: Government Employees Health Association (GEHA) Commercial $9.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $6.47
Rate for Payer: HealthUtah PPO $9.81
Rate for Payer: Idaho Integrated Healthcare Commercial $9.52
Rate for Payer: Multiplan Medicare/VA $6.15
Rate for Payer: One Health Plan of WY PPO $9.61
Rate for Payer: PacificSource Commercial $8.83
Rate for Payer: PHCS PPO $9.61
Rate for Payer: Three Rivers PPO $7.36
Rate for Payer: TriWest Veterans Administration $6.47
Rate for Payer: United Healthcare Commercial $8.53
Rate for Payer: United Healthcare Medicare $6.47
Rate for Payer: WINHealth Partners Commercial $9.32
Rate for Payer: Wise Provider Network Commercial $9.32
Service Code NDC 0023024004
Hospital Revenue Code 250
Min. Negotiated Rate $5.41
Max. Negotiated Rate $9.81
Rate for Payer: Aetna of WY Commercial/Medical Rental $9.61
Rate for Payer: Aetna of WY Medicare $6.47
Rate for Payer: Altius Auto/Workers Compensation $9.42
Rate for Payer: Altius Commercial $9.42
Rate for Payer: Beech Street Commercial $9.61
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $8.05
Rate for Payer: Cash Price $6.86
Rate for Payer: ChoiceCare Network Commercial $9.52
Rate for Payer: Cigna of WY Commercial $9.61
Rate for Payer: Entrust Commercial $9.32
Rate for Payer: First Choice Health Commercial $9.32
Rate for Payer: Government Employees Health Association (GEHA) Commercial $9.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5.69
Rate for Payer: HealthUtah PPO $9.81
Rate for Payer: Idaho Integrated Healthcare Commercial $9.52
Rate for Payer: Multiplan Medicare/VA $5.41
Rate for Payer: One Health Plan of WY PPO $9.61
Rate for Payer: PacificSource Commercial $8.83
Rate for Payer: PHCS PPO $9.61
Rate for Payer: Three Rivers PPO $7.36
Rate for Payer: TriWest Veterans Administration $5.69
Rate for Payer: United Healthcare Commercial $8.53
Rate for Payer: United Healthcare Medicare $5.69
Rate for Payer: WINHealth Partners Commercial $9.61
Rate for Payer: Wise Provider Network Commercial $9.32
Service Code NDC 0023066704
Hospital Revenue Code 250
Min. Negotiated Rate $6.15
Max. Negotiated Rate $9.81
Rate for Payer: Aetna of WY Commercial/Medical Rental $9.61
Rate for Payer: Altius Auto/Workers Compensation $9.42
Rate for Payer: Altius Commercial $9.42
Rate for Payer: Beech Street Commercial $9.61
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $8.05
Rate for Payer: Cash Price $6.86
Rate for Payer: ChoiceCare Network Commercial $9.52
Rate for Payer: Cigna of WY Commercial $9.61
Rate for Payer: Entrust Commercial $9.32
Rate for Payer: First Choice Health Commercial $9.32
Rate for Payer: Government Employees Health Association (GEHA) Commercial $9.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $6.47
Rate for Payer: HealthUtah PPO $9.81
Rate for Payer: Idaho Integrated Healthcare Commercial $9.52
Rate for Payer: Multiplan Medicare/VA $6.15
Rate for Payer: One Health Plan of WY PPO $9.61
Rate for Payer: PacificSource Commercial $8.83
Rate for Payer: PHCS PPO $9.61
Rate for Payer: Three Rivers PPO $7.36
Rate for Payer: TriWest Veterans Administration $6.47
Rate for Payer: United Healthcare Commercial $8.53
Rate for Payer: United Healthcare Medicare $6.47
Rate for Payer: WINHealth Partners Commercial $9.32
Rate for Payer: Wise Provider Network Commercial $9.32
Service Code NDC 0023066704
Hospital Revenue Code 250
Min. Negotiated Rate $5.41
Max. Negotiated Rate $9.81
Rate for Payer: Aetna of WY Commercial/Medical Rental $9.61
Rate for Payer: Aetna of WY Medicare $6.47
Rate for Payer: Altius Auto/Workers Compensation $9.42
Rate for Payer: Altius Commercial $9.42
Rate for Payer: Beech Street Commercial $9.61
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $8.05
Rate for Payer: Cash Price $6.86
Rate for Payer: ChoiceCare Network Commercial $9.52
Rate for Payer: Cigna of WY Commercial $9.61
Rate for Payer: Entrust Commercial $9.32
Rate for Payer: First Choice Health Commercial $9.32
Rate for Payer: Government Employees Health Association (GEHA) Commercial $9.32
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5.69
Rate for Payer: HealthUtah PPO $9.81
Rate for Payer: Idaho Integrated Healthcare Commercial $9.52
Rate for Payer: Multiplan Medicare/VA $5.41
Rate for Payer: One Health Plan of WY PPO $9.61
Rate for Payer: PacificSource Commercial $8.83
Rate for Payer: PHCS PPO $9.61
Rate for Payer: Three Rivers PPO $7.36
Rate for Payer: TriWest Veterans Administration $5.69
Rate for Payer: United Healthcare Commercial $8.53
Rate for Payer: United Healthcare Medicare $5.69
Rate for Payer: WINHealth Partners Commercial $9.61
Rate for Payer: Wise Provider Network Commercial $9.32
Service Code NDC 0065050935
Hospital Revenue Code 250
Min. Negotiated Rate $5.84
Max. Negotiated Rate $9.31
Rate for Payer: Aetna of WY Commercial/Medical Rental $9.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $10.08
Rate for Payer: Altius Auto/Workers Compensation $8.94
Rate for Payer: Altius Auto/Workers Compensation $9.88
Rate for Payer: Altius Commercial $9.88
Rate for Payer: Altius Commercial $8.94
Rate for Payer: Beech Street Commercial $9.12
Rate for Payer: Beech Street Commercial $10.08
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $8.45
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $7.64
Rate for Payer: Cash Price $6.52
Rate for Payer: Cash Price $7.21
Rate for Payer: ChoiceCare Network Commercial $9.98
Rate for Payer: ChoiceCare Network Commercial $9.03
Rate for Payer: Cigna of WY Commercial $9.12
Rate for Payer: Cigna of WY Commercial $10.08
Rate for Payer: Entrust Commercial $9.78
Rate for Payer: Entrust Commercial $8.84
Rate for Payer: First Choice Health Commercial $9.78
Rate for Payer: First Choice Health Commercial $8.84
Rate for Payer: Government Employees Health Association (GEHA) Commercial $9.78
Rate for Payer: Government Employees Health Association (GEHA) Commercial $8.84
Rate for Payer: Government Employees Health Association (GEHA) Medicare $6.14
Rate for Payer: Government Employees Health Association (GEHA) Medicare $6.79
Rate for Payer: HealthUtah PPO $9.31
Rate for Payer: HealthUtah PPO $10.29
Rate for Payer: Idaho Integrated Healthcare Commercial $9.98
Rate for Payer: Idaho Integrated Healthcare Commercial $9.03
Rate for Payer: Multiplan Medicare/VA $5.84
Rate for Payer: Multiplan Medicare/VA $6.45
Rate for Payer: One Health Plan of WY PPO $9.12
Rate for Payer: One Health Plan of WY PPO $10.08
Rate for Payer: PacificSource Commercial $8.38
Rate for Payer: PacificSource Commercial $9.26
Rate for Payer: PHCS PPO $10.08
Rate for Payer: PHCS PPO $9.12
Rate for Payer: Three Rivers PPO $7.72
Rate for Payer: Three Rivers PPO $6.98
Rate for Payer: TriWest Veterans Administration $6.14
Rate for Payer: TriWest Veterans Administration $6.79
Rate for Payer: United Healthcare Commercial $8.95
Rate for Payer: United Healthcare Commercial $8.10
Rate for Payer: United Healthcare Medicare $6.14
Rate for Payer: United Healthcare Medicare $6.79
Rate for Payer: WINHealth Partners Commercial $9.78
Rate for Payer: WINHealth Partners Commercial $8.84
Rate for Payer: Wise Provider Network Commercial $9.78
Rate for Payer: Wise Provider Network Commercial $8.84
Service Code NDC 0065050935
Hospital Revenue Code 250
Min. Negotiated Rate $5.13
Max. Negotiated Rate $9.31
Rate for Payer: Aetna of WY Commercial/Medical Rental $9.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $10.08
Rate for Payer: Aetna of WY Medicare $6.14
Rate for Payer: Aetna of WY Medicare $6.79
Rate for Payer: Altius Auto/Workers Compensation $9.88
Rate for Payer: Altius Auto/Workers Compensation $8.94
Rate for Payer: Altius Commercial $8.94
Rate for Payer: Altius Commercial $9.88
Rate for Payer: Beech Street Commercial $10.08
Rate for Payer: Beech Street Commercial $9.12
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $7.64
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $8.45
Rate for Payer: Cash Price $7.21
Rate for Payer: Cash Price $6.52
Rate for Payer: ChoiceCare Network Commercial $9.03
Rate for Payer: ChoiceCare Network Commercial $9.98
Rate for Payer: Cigna of WY Commercial $10.08
Rate for Payer: Cigna of WY Commercial $9.12
Rate for Payer: Entrust Commercial $8.84
Rate for Payer: Entrust Commercial $9.78
Rate for Payer: First Choice Health Commercial $9.78
Rate for Payer: First Choice Health Commercial $8.84
Rate for Payer: Government Employees Health Association (GEHA) Commercial $9.78
Rate for Payer: Government Employees Health Association (GEHA) Commercial $8.84
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $5.97
Rate for Payer: HealthUtah PPO $10.29
Rate for Payer: HealthUtah PPO $9.31
Rate for Payer: Idaho Integrated Healthcare Commercial $9.98
Rate for Payer: Idaho Integrated Healthcare Commercial $9.03
Rate for Payer: Multiplan Medicare/VA $5.13
Rate for Payer: Multiplan Medicare/VA $5.67
Rate for Payer: One Health Plan of WY PPO $10.08
Rate for Payer: One Health Plan of WY PPO $9.12
Rate for Payer: PacificSource Commercial $8.38
Rate for Payer: PacificSource Commercial $9.26
Rate for Payer: PHCS PPO $10.08
Rate for Payer: PHCS PPO $9.12
Rate for Payer: Three Rivers PPO $7.72
Rate for Payer: Three Rivers PPO $6.98
Rate for Payer: TriWest Veterans Administration $5.40
Rate for Payer: TriWest Veterans Administration $5.97
Rate for Payer: United Healthcare Commercial $8.95
Rate for Payer: United Healthcare Commercial $8.10
Rate for Payer: United Healthcare Medicare $5.40
Rate for Payer: United Healthcare Medicare $5.97
Rate for Payer: WINHealth Partners Commercial $10.08
Rate for Payer: WINHealth Partners Commercial $9.12
Rate for Payer: Wise Provider Network Commercial $9.78
Rate for Payer: Wise Provider Network Commercial $8.84
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $36.07
Max. Negotiated Rate $57.53
Rate for Payer: Aetna of WY Commercial/Medical Rental $56.38
Rate for Payer: Altius Auto/Workers Compensation $55.23
Rate for Payer: Altius Commercial $55.23
Rate for Payer: Beech Street Commercial $56.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $47.23
Rate for Payer: Cash Price $40.27
Rate for Payer: ChoiceCare Network Commercial $55.80
Rate for Payer: Cigna of WY Commercial $56.38
Rate for Payer: Entrust Commercial $54.65
Rate for Payer: First Choice Health Commercial $54.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $54.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $37.97
Rate for Payer: HealthUtah PPO $57.53
Rate for Payer: Idaho Integrated Healthcare Commercial $55.80
Rate for Payer: Multiplan Medicare/VA $36.07
Rate for Payer: One Health Plan of WY PPO $56.38
Rate for Payer: PacificSource Commercial $51.78
Rate for Payer: PHCS PPO $56.38
Rate for Payer: Three Rivers PPO $43.15
Rate for Payer: TriWest Veterans Administration $37.97
Rate for Payer: United Healthcare Commercial $50.05
Rate for Payer: United Healthcare Medicare $37.97
Rate for Payer: WINHealth Partners Commercial $54.65
Rate for Payer: Wise Provider Network Commercial $54.65
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $31.70
Max. Negotiated Rate $57.53
Rate for Payer: Aetna of WY Commercial/Medical Rental $56.38
Rate for Payer: Aetna of WY Medicare $37.97
Rate for Payer: Altius Auto/Workers Compensation $55.23
Rate for Payer: Altius Commercial $55.23
Rate for Payer: Beech Street Commercial $56.38
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $47.23
Rate for Payer: Cash Price $40.27
Rate for Payer: ChoiceCare Network Commercial $55.80
Rate for Payer: Cigna of WY Commercial $56.38
Rate for Payer: Entrust Commercial $54.65
Rate for Payer: First Choice Health Commercial $54.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $54.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $33.37
Rate for Payer: HealthUtah PPO $57.53
Rate for Payer: Idaho Integrated Healthcare Commercial $55.80
Rate for Payer: Multiplan Medicare/VA $31.70
Rate for Payer: One Health Plan of WY PPO $56.38
Rate for Payer: PacificSource Commercial $51.78
Rate for Payer: PHCS PPO $56.38
Rate for Payer: Three Rivers PPO $43.15
Rate for Payer: TriWest Veterans Administration $33.37
Rate for Payer: United Healthcare Commercial $50.05
Rate for Payer: United Healthcare Medicare $33.37
Rate for Payer: WINHealth Partners Commercial $56.38
Rate for Payer: Wise Provider Network Commercial $54.65
Service Code HCPCS L3908
Hospital Charge Code L3908
Min. Negotiated Rate $67.50
Max. Negotiated Rate $90.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $88.20
Rate for Payer: Beech Street Commercial $85.50
Rate for Payer: Cash Price $63.00
Rate for Payer: ChoiceCare Network Commercial $87.30
Rate for Payer: Cigna of WY Commercial $88.20
Rate for Payer: First Choice Health Commercial $81.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $85.50
Rate for Payer: HealthUtah PPO $90.00
Rate for Payer: Idaho Integrated Healthcare Commercial $87.30
Rate for Payer: One Health Plan of WY PPO $88.20
Rate for Payer: PacificSource Commercial $81.00
Rate for Payer: PHCS PPO $85.50
Rate for Payer: Three Rivers PPO $67.50
Rate for Payer: United Healthcare Commercial $78.30
Rate for Payer: WINHealth Partners Commercial $85.50
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $247.98
Max. Negotiated Rate $395.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $387.59
Rate for Payer: Altius Auto/Workers Compensation $379.68
Rate for Payer: Altius Commercial $379.68
Rate for Payer: Beech Street Commercial $387.59
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $324.71
Rate for Payer: Cash Price $276.85
Rate for Payer: ChoiceCare Network Commercial $383.64
Rate for Payer: Cigna of WY Commercial $387.59
Rate for Payer: Entrust Commercial $375.72
Rate for Payer: First Choice Health Commercial $375.72
Rate for Payer: Government Employees Health Association (GEHA) Commercial $375.72
Rate for Payer: Government Employees Health Association (GEHA) Medicare $261.03
Rate for Payer: HealthUtah PPO $395.50
Rate for Payer: Idaho Integrated Healthcare Commercial $383.64
Rate for Payer: Multiplan Medicare/VA $247.98
Rate for Payer: One Health Plan of WY PPO $387.59
Rate for Payer: PacificSource Commercial $355.95
Rate for Payer: PHCS PPO $387.59
Rate for Payer: Three Rivers PPO $296.62
Rate for Payer: TriWest Veterans Administration $261.03
Rate for Payer: United Healthcare Commercial $344.08
Rate for Payer: United Healthcare Medicare $261.03
Rate for Payer: WINHealth Partners Commercial $375.72
Rate for Payer: Wise Provider Network Commercial $375.72
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $217.92
Max. Negotiated Rate $395.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $387.59
Rate for Payer: Aetna of WY Medicare $261.03
Rate for Payer: Altius Auto/Workers Compensation $379.68
Rate for Payer: Altius Commercial $379.68
Rate for Payer: Beech Street Commercial $387.59
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $324.71
Rate for Payer: Cash Price $276.85
Rate for Payer: ChoiceCare Network Commercial $383.64
Rate for Payer: Cigna of WY Commercial $387.59
Rate for Payer: Entrust Commercial $375.72
Rate for Payer: First Choice Health Commercial $375.72
Rate for Payer: Government Employees Health Association (GEHA) Commercial $375.72
Rate for Payer: Government Employees Health Association (GEHA) Medicare $229.39
Rate for Payer: HealthUtah PPO $395.50
Rate for Payer: Idaho Integrated Healthcare Commercial $383.64
Rate for Payer: Multiplan Medicare/VA $217.92
Rate for Payer: One Health Plan of WY PPO $387.59
Rate for Payer: PacificSource Commercial $355.95
Rate for Payer: PHCS PPO $387.59
Rate for Payer: Three Rivers PPO $296.62
Rate for Payer: TriWest Veterans Administration $229.39
Rate for Payer: United Healthcare Commercial $344.08
Rate for Payer: United Healthcare Medicare $229.39
Rate for Payer: WINHealth Partners Commercial $387.59
Rate for Payer: Wise Provider Network Commercial $375.72
Service Code HCPCS L3905
Hospital Charge Code L3905
Min. Negotiated Rate $1,104.75
Max. Negotiated Rate $1,473.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $1,443.54
Rate for Payer: Beech Street Commercial $1,399.35
Rate for Payer: Cash Price $1,031.10
Rate for Payer: ChoiceCare Network Commercial $1,428.81
Rate for Payer: Cigna of WY Commercial $1,443.54
Rate for Payer: First Choice Health Commercial $1,325.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1,399.35
Rate for Payer: HealthUtah PPO $1,473.00
Rate for Payer: Idaho Integrated Healthcare Commercial $1,428.81
Rate for Payer: One Health Plan of WY PPO $1,443.54
Rate for Payer: PacificSource Commercial $1,325.70
Rate for Payer: PHCS PPO $1,399.35
Rate for Payer: Three Rivers PPO $1,104.75
Rate for Payer: United Healthcare Commercial $1,281.51
Rate for Payer: WINHealth Partners Commercial $1,399.35
Service Code HCPCS L3906
Hospital Charge Code L3906
Min. Negotiated Rate $453.00
Max. Negotiated Rate $604.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $591.92
Rate for Payer: Beech Street Commercial $573.80
Rate for Payer: Cash Price $422.80
Rate for Payer: ChoiceCare Network Commercial $585.88
Rate for Payer: Cigna of WY Commercial $591.92
Rate for Payer: First Choice Health Commercial $543.60
Rate for Payer: Government Employees Health Association (GEHA) Commercial $573.80
Rate for Payer: HealthUtah PPO $604.00
Rate for Payer: Idaho Integrated Healthcare Commercial $585.88
Rate for Payer: One Health Plan of WY PPO $591.92
Rate for Payer: PacificSource Commercial $543.60
Rate for Payer: PHCS PPO $573.80
Rate for Payer: Three Rivers PPO $453.00
Rate for Payer: United Healthcare Commercial $525.48
Rate for Payer: WINHealth Partners Commercial $573.80
Service Code NDC 0904682960
Hospital Revenue Code 250
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.16
Rate for Payer: Altius Auto/Workers Compensation $0.15
Rate for Payer: Altius Commercial $0.15
Rate for Payer: Beech Street Commercial $0.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.13
Rate for Payer: Cash Price $0.11
Rate for Payer: ChoiceCare Network Commercial $0.16
Rate for Payer: Cigna of WY Commercial $0.16
Rate for Payer: Entrust Commercial $0.15
Rate for Payer: First Choice Health Commercial $0.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.11
Rate for Payer: HealthUtah PPO $0.16
Rate for Payer: Idaho Integrated Healthcare Commercial $0.16
Rate for Payer: Multiplan Medicare/VA $0.10
Rate for Payer: One Health Plan of WY PPO $0.16
Rate for Payer: PacificSource Commercial $0.14
Rate for Payer: PHCS PPO $0.16
Rate for Payer: Three Rivers PPO $0.12
Rate for Payer: TriWest Veterans Administration $0.11
Rate for Payer: United Healthcare Commercial $0.14
Rate for Payer: United Healthcare Medicare $0.11
Rate for Payer: WINHealth Partners Commercial $0.15
Rate for Payer: Wise Provider Network Commercial $0.15
Service Code NDC 0904682960
Hospital Revenue Code 250
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.16
Rate for Payer: Aetna of WY Medicare $0.11
Rate for Payer: Altius Auto/Workers Compensation $0.15
Rate for Payer: Altius Commercial $0.15
Rate for Payer: Beech Street Commercial $0.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.13
Rate for Payer: Cash Price $0.11
Rate for Payer: ChoiceCare Network Commercial $0.16
Rate for Payer: Cigna of WY Commercial $0.16
Rate for Payer: Entrust Commercial $0.15
Rate for Payer: First Choice Health Commercial $0.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.09
Rate for Payer: HealthUtah PPO $0.16
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 $0.16
Rate for Payer: PacificSource Commercial $0.14
Rate for Payer: PHCS PPO $0.16
Rate for Payer: Three Rivers PPO $0.12
Rate for Payer: TriWest Veterans Administration $0.09
Rate for Payer: United Healthcare Commercial $0.14
Rate for Payer: United Healthcare Medicare $0.09
Rate for Payer: WINHealth Partners Commercial $0.16
Rate for Payer: Wise Provider Network Commercial $0.15
Service Code NDC 7139901101
Hospital Revenue Code 250
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.16
Rate for Payer: Altius Auto/Workers Compensation $0.15
Rate for Payer: Altius Commercial $0.15
Rate for Payer: Beech Street Commercial $0.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.13
Rate for Payer: Cash Price $0.11
Rate for Payer: ChoiceCare Network Commercial $0.16
Rate for Payer: Cigna of WY Commercial $0.16
Rate for Payer: Entrust Commercial $0.15
Rate for Payer: First Choice Health Commercial $0.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.11
Rate for Payer: HealthUtah PPO $0.16
Rate for Payer: Idaho Integrated Healthcare Commercial $0.16
Rate for Payer: Multiplan Medicare/VA $0.10
Rate for Payer: One Health Plan of WY PPO $0.16
Rate for Payer: PacificSource Commercial $0.14
Rate for Payer: PHCS PPO $0.16
Rate for Payer: Three Rivers PPO $0.12
Rate for Payer: TriWest Veterans Administration $0.11
Rate for Payer: United Healthcare Commercial $0.14
Rate for Payer: United Healthcare Medicare $0.11
Rate for Payer: WINHealth Partners Commercial $0.15
Rate for Payer: Wise Provider Network Commercial $0.15
Service Code NDC 7139901101
Hospital Revenue Code 250
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.16
Rate for Payer: Aetna of WY Medicare $0.11
Rate for Payer: Altius Auto/Workers Compensation $0.15
Rate for Payer: Altius Commercial $0.15
Rate for Payer: Beech Street Commercial $0.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.13
Rate for Payer: Cash Price $0.11
Rate for Payer: ChoiceCare Network Commercial $0.16
Rate for Payer: Cigna of WY Commercial $0.16
Rate for Payer: Entrust Commercial $0.15
Rate for Payer: First Choice Health Commercial $0.15
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.15
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.09
Rate for Payer: HealthUtah PPO $0.16
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 $0.16
Rate for Payer: PacificSource Commercial $0.14
Rate for Payer: PHCS PPO $0.16
Rate for Payer: Three Rivers PPO $0.12
Rate for Payer: TriWest Veterans Administration $0.09
Rate for Payer: United Healthcare Commercial $0.14
Rate for Payer: United Healthcare Medicare $0.09
Rate for Payer: WINHealth Partners Commercial $0.16
Rate for Payer: Wise Provider Network Commercial $0.15
Service Code NDC 9999400791
Hospital Revenue Code 250
Min. Negotiated Rate $0.73
Max. Negotiated Rate $1.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.14
Rate for Payer: Altius Auto/Workers Compensation $1.11
Rate for Payer: Altius Commercial $1.11
Rate for Payer: Beech Street Commercial $1.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.95
Rate for Payer: Cash Price $0.81
Rate for Payer: ChoiceCare Network Commercial $1.13
Rate for Payer: Cigna of WY Commercial $1.14
Rate for Payer: Entrust Commercial $1.10
Rate for Payer: First Choice Health Commercial $1.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.77
Rate for Payer: HealthUtah PPO $1.16
Rate for Payer: Idaho Integrated Healthcare Commercial $1.13
Rate for Payer: Multiplan Medicare/VA $0.73
Rate for Payer: One Health Plan of WY PPO $1.14
Rate for Payer: PacificSource Commercial $1.04
Rate for Payer: PHCS PPO $1.14
Rate for Payer: Three Rivers PPO $0.87
Rate for Payer: TriWest Veterans Administration $0.77
Rate for Payer: United Healthcare Commercial $1.01
Rate for Payer: United Healthcare Medicare $0.77
Rate for Payer: WINHealth Partners Commercial $1.10
Rate for Payer: Wise Provider Network Commercial $1.10
Service Code NDC 9999400791
Hospital Revenue Code 250
Min. Negotiated Rate $0.64
Max. Negotiated Rate $1.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.14
Rate for Payer: Aetna of WY Medicare $0.77
Rate for Payer: Altius Auto/Workers Compensation $1.11
Rate for Payer: Altius Commercial $1.11
Rate for Payer: Beech Street Commercial $1.14
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.95
Rate for Payer: Cash Price $0.81
Rate for Payer: ChoiceCare Network Commercial $1.13
Rate for Payer: Cigna of WY Commercial $1.14
Rate for Payer: Entrust Commercial $1.10
Rate for Payer: First Choice Health Commercial $1.10
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.10
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.67
Rate for Payer: HealthUtah PPO $1.16
Rate for Payer: Idaho Integrated Healthcare Commercial $1.13
Rate for Payer: Multiplan Medicare/VA $0.64
Rate for Payer: One Health Plan of WY PPO $1.14
Rate for Payer: PacificSource Commercial $1.04
Rate for Payer: PHCS PPO $1.14
Rate for Payer: Three Rivers PPO $0.87
Rate for Payer: TriWest Veterans Administration $0.67
Rate for Payer: United Healthcare Commercial $1.01
Rate for Payer: United Healthcare Medicare $0.67
Rate for Payer: WINHealth Partners Commercial $1.14
Rate for Payer: Wise Provider Network Commercial $1.10
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $1,465.66
Max. Negotiated Rate $2,660.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $2,606.80
Rate for Payer: Aetna of WY Medicare $1,755.60
Rate for Payer: Altius Auto/Workers Compensation $2,553.60
Rate for Payer: Altius Commercial $2,553.60
Rate for Payer: Beech Street Commercial $2,606.80
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,183.86
Rate for Payer: Cash Price $1,862.00
Rate for Payer: ChoiceCare Network Commercial $2,580.20
Rate for Payer: Cigna of WY Commercial $2,606.80
Rate for Payer: Entrust Commercial $2,527.00
Rate for Payer: First Choice Health Commercial $2,527.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,527.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,542.80
Rate for Payer: HealthUtah PPO $2,660.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,580.20
Rate for Payer: Multiplan Medicare/VA $1,465.66
Rate for Payer: One Health Plan of WY PPO $2,606.80
Rate for Payer: PacificSource Commercial $2,394.00
Rate for Payer: PHCS PPO $2,606.80
Rate for Payer: Three Rivers PPO $1,995.00
Rate for Payer: TriWest Veterans Administration $1,542.80
Rate for Payer: United Healthcare Commercial $2,314.20
Rate for Payer: United Healthcare Medicare $1,542.80
Rate for Payer: WINHealth Partners Commercial $2,606.80
Rate for Payer: Wise Provider Network Commercial $2,527.00