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Service Code NDC 7733398310
Hospital Revenue Code 250
Min. Negotiated Rate $0.52
Max. Negotiated Rate $0.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.92
Rate for Payer: Aetna of WY Medicare $0.62
Rate for Payer: Altius Auto/Workers Compensation $0.90
Rate for Payer: Altius Commercial $0.90
Rate for Payer: Beech Street Commercial $0.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.77
Rate for Payer: Cash Price $0.66
Rate for Payer: ChoiceCare Network Commercial $0.91
Rate for Payer: Cigna of WY Commercial $0.92
Rate for Payer: Entrust Commercial $0.89
Rate for Payer: First Choice Health Commercial $0.89
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.89
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.55
Rate for Payer: HealthUtah PPO $0.94
Rate for Payer: Idaho Integrated Healthcare Commercial $0.91
Rate for Payer: Multiplan Medicare/VA $0.52
Rate for Payer: One Health Plan of WY PPO $0.92
Rate for Payer: PacificSource Commercial $0.85
Rate for Payer: PHCS PPO $0.92
Rate for Payer: Three Rivers PPO $0.71
Rate for Payer: TriWest Veterans Administration $0.55
Rate for Payer: United Healthcare Commercial $0.82
Rate for Payer: United Healthcare Medicare $0.55
Rate for Payer: WINHealth Partners Commercial $0.92
Rate for Payer: Wise Provider Network Commercial $0.89
Service Code NDC 7733398325
Hospital Revenue Code 250
Min. Negotiated Rate $0.59
Max. Negotiated Rate $0.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.92
Rate for Payer: Altius Auto/Workers Compensation $0.90
Rate for Payer: Altius Commercial $0.90
Rate for Payer: Beech Street Commercial $0.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.77
Rate for Payer: Cash Price $0.66
Rate for Payer: ChoiceCare Network Commercial $0.91
Rate for Payer: Cigna of WY Commercial $0.92
Rate for Payer: Entrust Commercial $0.89
Rate for Payer: First Choice Health Commercial $0.89
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.89
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.62
Rate for Payer: HealthUtah PPO $0.94
Rate for Payer: Idaho Integrated Healthcare Commercial $0.91
Rate for Payer: Multiplan Medicare/VA $0.59
Rate for Payer: One Health Plan of WY PPO $0.92
Rate for Payer: PacificSource Commercial $0.85
Rate for Payer: PHCS PPO $0.92
Rate for Payer: Three Rivers PPO $0.71
Rate for Payer: TriWest Veterans Administration $0.62
Rate for Payer: United Healthcare Commercial $0.82
Rate for Payer: United Healthcare Medicare $0.62
Rate for Payer: WINHealth Partners Commercial $0.89
Rate for Payer: Wise Provider Network Commercial $0.89
Service Code NDC 7733398325
Hospital Revenue Code 250
Min. Negotiated Rate $0.52
Max. Negotiated Rate $0.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.92
Rate for Payer: Aetna of WY Medicare $0.62
Rate for Payer: Altius Auto/Workers Compensation $0.90
Rate for Payer: Altius Commercial $0.90
Rate for Payer: Beech Street Commercial $0.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.77
Rate for Payer: Cash Price $0.66
Rate for Payer: ChoiceCare Network Commercial $0.91
Rate for Payer: Cigna of WY Commercial $0.92
Rate for Payer: Entrust Commercial $0.89
Rate for Payer: First Choice Health Commercial $0.89
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.89
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.55
Rate for Payer: HealthUtah PPO $0.94
Rate for Payer: Idaho Integrated Healthcare Commercial $0.91
Rate for Payer: Multiplan Medicare/VA $0.52
Rate for Payer: One Health Plan of WY PPO $0.92
Rate for Payer: PacificSource Commercial $0.85
Rate for Payer: PHCS PPO $0.92
Rate for Payer: Three Rivers PPO $0.71
Rate for Payer: TriWest Veterans Administration $0.55
Rate for Payer: United Healthcare Commercial $0.82
Rate for Payer: United Healthcare Medicare $0.55
Rate for Payer: WINHealth Partners Commercial $0.92
Rate for Payer: Wise Provider Network Commercial $0.89
Service Code HCPCS J3489
Hospital Revenue Code 636
Min. Negotiated Rate $13.92
Max. Negotiated Rate $22.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $21.76
Rate for Payer: Altius Auto/Workers Compensation $21.31
Rate for Payer: Altius Commercial $21.31
Rate for Payer: Beech Street Commercial $21.76
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $18.23
Rate for Payer: Cash Price $15.54
Rate for Payer: ChoiceCare Network Commercial $21.53
Rate for Payer: Cigna of WY Commercial $21.76
Rate for Payer: Entrust Commercial $21.09
Rate for Payer: First Choice Health Commercial $21.09
Rate for Payer: Government Employees Health Association (GEHA) Commercial $21.09
Rate for Payer: Government Employees Health Association (GEHA) Medicare $14.65
Rate for Payer: HealthUtah PPO $22.20
Rate for Payer: Idaho Integrated Healthcare Commercial $21.53
Rate for Payer: Multiplan Medicare/VA $13.92
Rate for Payer: One Health Plan of WY PPO $21.76
Rate for Payer: PacificSource Commercial $19.98
Rate for Payer: PHCS PPO $21.76
Rate for Payer: Three Rivers PPO $16.65
Rate for Payer: TriWest Veterans Administration $14.65
Rate for Payer: United Healthcare Commercial $19.31
Rate for Payer: United Healthcare Medicare $14.65
Rate for Payer: WINHealth Partners Commercial $21.09
Rate for Payer: Wise Provider Network Commercial $21.09
Service Code HCPCS J3489
Hospital Revenue Code 636
Min. Negotiated Rate $12.23
Max. Negotiated Rate $22.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $21.76
Rate for Payer: Aetna of WY Medicare $14.65
Rate for Payer: Altius Auto/Workers Compensation $21.31
Rate for Payer: Altius Commercial $21.31
Rate for Payer: Beech Street Commercial $21.76
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $18.23
Rate for Payer: Cash Price $15.54
Rate for Payer: ChoiceCare Network Commercial $21.53
Rate for Payer: Cigna of WY Commercial $21.76
Rate for Payer: Entrust Commercial $21.09
Rate for Payer: First Choice Health Commercial $21.09
Rate for Payer: Government Employees Health Association (GEHA) Commercial $21.09
Rate for Payer: Government Employees Health Association (GEHA) Medicare $12.88
Rate for Payer: HealthUtah PPO $22.20
Rate for Payer: Idaho Integrated Healthcare Commercial $21.53
Rate for Payer: Multiplan Medicare/VA $12.23
Rate for Payer: One Health Plan of WY PPO $21.76
Rate for Payer: PacificSource Commercial $19.98
Rate for Payer: PHCS PPO $21.76
Rate for Payer: Three Rivers PPO $16.65
Rate for Payer: TriWest Veterans Administration $12.88
Rate for Payer: United Healthcare Commercial $19.31
Rate for Payer: United Healthcare Medicare $12.88
Rate for Payer: WINHealth Partners Commercial $21.76
Rate for Payer: Wise Provider Network Commercial $21.09
Service Code HCPCS J3489
Hospital Revenue Code 636
Min. Negotiated Rate $10.69
Max. Negotiated Rate $19.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $19.01
Rate for Payer: Aetna of WY Commercial/Medical Rental $18.62
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.72
Rate for Payer: Aetna of WY Medicare $12.80
Rate for Payer: Aetna of WY Medicare $17.32
Rate for Payer: Aetna of WY Medicare $12.54
Rate for Payer: Altius Auto/Workers Compensation $18.62
Rate for Payer: Altius Auto/Workers Compensation $18.24
Rate for Payer: Altius Auto/Workers Compensation $25.20
Rate for Payer: Altius Commercial $18.62
Rate for Payer: Altius Commercial $25.20
Rate for Payer: Altius Commercial $18.24
Rate for Payer: Beech Street Commercial $19.01
Rate for Payer: Beech Street Commercial $25.72
Rate for Payer: Beech Street Commercial $18.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $15.93
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $15.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.55
Rate for Payer: Cash Price $13.58
Rate for Payer: Cash Price $13.30
Rate for Payer: Cash Price $18.38
Rate for Payer: ChoiceCare Network Commercial $18.82
Rate for Payer: ChoiceCare Network Commercial $25.46
Rate for Payer: ChoiceCare Network Commercial $18.43
Rate for Payer: Cigna of WY Commercial $25.72
Rate for Payer: Cigna of WY Commercial $18.62
Rate for Payer: Cigna of WY Commercial $19.01
Rate for Payer: Entrust Commercial $24.94
Rate for Payer: Entrust Commercial $18.43
Rate for Payer: Entrust Commercial $18.05
Rate for Payer: First Choice Health Commercial $18.43
Rate for Payer: First Choice Health Commercial $18.05
Rate for Payer: First Choice Health Commercial $24.94
Rate for Payer: Government Employees Health Association (GEHA) Commercial $18.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.94
Rate for Payer: Government Employees Health Association (GEHA) Commercial $18.43
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.25
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.02
Rate for Payer: Government Employees Health Association (GEHA) Medicare $15.22
Rate for Payer: HealthUtah PPO $19.00
Rate for Payer: HealthUtah PPO $26.25
Rate for Payer: HealthUtah PPO $19.40
Rate for Payer: Idaho Integrated Healthcare Commercial $25.46
Rate for Payer: Idaho Integrated Healthcare Commercial $18.43
Rate for Payer: Idaho Integrated Healthcare Commercial $18.82
Rate for Payer: Multiplan Medicare/VA $10.47
Rate for Payer: Multiplan Medicare/VA $10.69
Rate for Payer: Multiplan Medicare/VA $14.46
Rate for Payer: One Health Plan of WY PPO $18.62
Rate for Payer: One Health Plan of WY PPO $25.72
Rate for Payer: One Health Plan of WY PPO $19.01
Rate for Payer: PacificSource Commercial $23.62
Rate for Payer: PacificSource Commercial $17.46
Rate for Payer: PacificSource Commercial $17.10
Rate for Payer: PHCS PPO $19.01
Rate for Payer: PHCS PPO $18.62
Rate for Payer: PHCS PPO $25.72
Rate for Payer: Three Rivers PPO $14.55
Rate for Payer: Three Rivers PPO $14.25
Rate for Payer: Three Rivers PPO $19.69
Rate for Payer: TriWest Veterans Administration $15.22
Rate for Payer: TriWest Veterans Administration $11.25
Rate for Payer: TriWest Veterans Administration $11.02
Rate for Payer: United Healthcare Commercial $16.53
Rate for Payer: United Healthcare Commercial $16.88
Rate for Payer: United Healthcare Commercial $22.84
Rate for Payer: United Healthcare Medicare $15.22
Rate for Payer: United Healthcare Medicare $11.02
Rate for Payer: United Healthcare Medicare $11.25
Rate for Payer: WINHealth Partners Commercial $25.72
Rate for Payer: WINHealth Partners Commercial $18.62
Rate for Payer: WINHealth Partners Commercial $19.01
Rate for Payer: Wise Provider Network Commercial $18.05
Rate for Payer: Wise Provider Network Commercial $24.94
Rate for Payer: Wise Provider Network Commercial $18.43
Service Code HCPCS J3489
Hospital Revenue Code 636
Min. Negotiated Rate $11.91
Max. Negotiated Rate $19.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $18.62
Rate for Payer: Aetna of WY Commercial/Medical Rental $19.01
Rate for Payer: Aetna of WY Commercial/Medical Rental $25.72
Rate for Payer: Altius Auto/Workers Compensation $18.24
Rate for Payer: Altius Auto/Workers Compensation $18.62
Rate for Payer: Altius Auto/Workers Compensation $25.20
Rate for Payer: Altius Commercial $18.62
Rate for Payer: Altius Commercial $18.24
Rate for Payer: Altius Commercial $25.20
Rate for Payer: Beech Street Commercial $25.72
Rate for Payer: Beech Street Commercial $19.01
Rate for Payer: Beech Street Commercial $18.62
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $15.60
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $21.55
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $15.93
Rate for Payer: Cash Price $13.58
Rate for Payer: Cash Price $13.30
Rate for Payer: Cash Price $18.38
Rate for Payer: ChoiceCare Network Commercial $18.43
Rate for Payer: ChoiceCare Network Commercial $25.46
Rate for Payer: ChoiceCare Network Commercial $18.82
Rate for Payer: Cigna of WY Commercial $19.01
Rate for Payer: Cigna of WY Commercial $25.72
Rate for Payer: Cigna of WY Commercial $18.62
Rate for Payer: Entrust Commercial $24.94
Rate for Payer: Entrust Commercial $18.05
Rate for Payer: Entrust Commercial $18.43
Rate for Payer: First Choice Health Commercial $18.43
Rate for Payer: First Choice Health Commercial $24.94
Rate for Payer: First Choice Health Commercial $18.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $18.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $24.94
Rate for Payer: Government Employees Health Association (GEHA) Commercial $18.43
Rate for Payer: Government Employees Health Association (GEHA) Medicare $12.54
Rate for Payer: Government Employees Health Association (GEHA) Medicare $12.80
Rate for Payer: Government Employees Health Association (GEHA) Medicare $17.32
Rate for Payer: HealthUtah PPO $19.00
Rate for Payer: HealthUtah PPO $19.40
Rate for Payer: HealthUtah PPO $26.25
Rate for Payer: Idaho Integrated Healthcare Commercial $25.46
Rate for Payer: Idaho Integrated Healthcare Commercial $18.82
Rate for Payer: Idaho Integrated Healthcare Commercial $18.43
Rate for Payer: Multiplan Medicare/VA $16.46
Rate for Payer: Multiplan Medicare/VA $11.91
Rate for Payer: Multiplan Medicare/VA $12.16
Rate for Payer: One Health Plan of WY PPO $18.62
Rate for Payer: One Health Plan of WY PPO $19.01
Rate for Payer: One Health Plan of WY PPO $25.72
Rate for Payer: PacificSource Commercial $23.62
Rate for Payer: PacificSource Commercial $17.10
Rate for Payer: PacificSource Commercial $17.46
Rate for Payer: PHCS PPO $19.01
Rate for Payer: PHCS PPO $18.62
Rate for Payer: PHCS PPO $25.72
Rate for Payer: Three Rivers PPO $14.55
Rate for Payer: Three Rivers PPO $14.25
Rate for Payer: Three Rivers PPO $19.69
Rate for Payer: TriWest Veterans Administration $12.80
Rate for Payer: TriWest Veterans Administration $12.54
Rate for Payer: TriWest Veterans Administration $17.32
Rate for Payer: United Healthcare Commercial $16.53
Rate for Payer: United Healthcare Commercial $22.84
Rate for Payer: United Healthcare Commercial $16.88
Rate for Payer: United Healthcare Medicare $12.54
Rate for Payer: United Healthcare Medicare $17.32
Rate for Payer: United Healthcare Medicare $12.80
Rate for Payer: WINHealth Partners Commercial $18.43
Rate for Payer: WINHealth Partners Commercial $18.05
Rate for Payer: WINHealth Partners Commercial $24.94
Rate for Payer: Wise Provider Network Commercial $24.94
Rate for Payer: Wise Provider Network Commercial $18.05
Rate for Payer: Wise Provider Network Commercial $18.43
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $17.79
Max. Negotiated Rate $28.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.81
Rate for Payer: Altius Auto/Workers Compensation $27.24
Rate for Payer: Altius Commercial $27.24
Rate for Payer: Beech Street Commercial $27.81
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $23.30
Rate for Payer: Cash Price $19.86
Rate for Payer: ChoiceCare Network Commercial $27.53
Rate for Payer: Cigna of WY Commercial $27.81
Rate for Payer: Entrust Commercial $26.96
Rate for Payer: First Choice Health Commercial $26.96
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.96
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.73
Rate for Payer: HealthUtah PPO $28.38
Rate for Payer: Idaho Integrated Healthcare Commercial $27.53
Rate for Payer: Multiplan Medicare/VA $17.79
Rate for Payer: One Health Plan of WY PPO $27.81
Rate for Payer: PacificSource Commercial $25.54
Rate for Payer: PHCS PPO $27.81
Rate for Payer: Three Rivers PPO $21.28
Rate for Payer: TriWest Veterans Administration $18.73
Rate for Payer: United Healthcare Commercial $24.69
Rate for Payer: United Healthcare Medicare $18.73
Rate for Payer: WINHealth Partners Commercial $26.96
Rate for Payer: Wise Provider Network Commercial $26.96
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $15.64
Max. Negotiated Rate $28.38
Rate for Payer: Aetna of WY Commercial/Medical Rental $27.81
Rate for Payer: Aetna of WY Medicare $18.73
Rate for Payer: Altius Auto/Workers Compensation $27.24
Rate for Payer: Altius Commercial $27.24
Rate for Payer: Beech Street Commercial $27.81
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $23.30
Rate for Payer: Cash Price $19.86
Rate for Payer: ChoiceCare Network Commercial $27.53
Rate for Payer: Cigna of WY Commercial $27.81
Rate for Payer: Entrust Commercial $26.96
Rate for Payer: First Choice Health Commercial $26.96
Rate for Payer: Government Employees Health Association (GEHA) Commercial $26.96
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.46
Rate for Payer: HealthUtah PPO $28.38
Rate for Payer: Idaho Integrated Healthcare Commercial $27.53
Rate for Payer: Multiplan Medicare/VA $15.64
Rate for Payer: One Health Plan of WY PPO $27.81
Rate for Payer: PacificSource Commercial $25.54
Rate for Payer: PHCS PPO $27.81
Rate for Payer: Three Rivers PPO $21.28
Rate for Payer: TriWest Veterans Administration $16.46
Rate for Payer: United Healthcare Commercial $24.69
Rate for Payer: United Healthcare Medicare $16.46
Rate for Payer: WINHealth Partners Commercial $27.81
Rate for Payer: Wise Provider Network Commercial $26.96
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $303.37
Max. Negotiated Rate $483.84
Rate for Payer: Aetna of WY Commercial/Medical Rental $474.16
Rate for Payer: Altius Auto/Workers Compensation $464.49
Rate for Payer: Altius Commercial $464.49
Rate for Payer: Beech Street Commercial $474.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $397.23
Rate for Payer: Cash Price $338.69
Rate for Payer: ChoiceCare Network Commercial $469.32
Rate for Payer: Cigna of WY Commercial $474.16
Rate for Payer: Entrust Commercial $459.65
Rate for Payer: First Choice Health Commercial $459.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $459.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $319.33
Rate for Payer: HealthUtah PPO $483.84
Rate for Payer: Idaho Integrated Healthcare Commercial $469.32
Rate for Payer: Multiplan Medicare/VA $303.37
Rate for Payer: One Health Plan of WY PPO $474.16
Rate for Payer: PacificSource Commercial $435.46
Rate for Payer: PHCS PPO $474.16
Rate for Payer: Three Rivers PPO $362.88
Rate for Payer: TriWest Veterans Administration $319.33
Rate for Payer: United Healthcare Commercial $420.94
Rate for Payer: United Healthcare Medicare $319.33
Rate for Payer: WINHealth Partners Commercial $459.65
Rate for Payer: Wise Provider Network Commercial $459.65
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $266.60
Max. Negotiated Rate $483.84
Rate for Payer: Aetna of WY Commercial/Medical Rental $474.16
Rate for Payer: Aetna of WY Medicare $319.33
Rate for Payer: Altius Auto/Workers Compensation $464.49
Rate for Payer: Altius Commercial $464.49
Rate for Payer: Beech Street Commercial $474.16
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $397.23
Rate for Payer: Cash Price $338.69
Rate for Payer: ChoiceCare Network Commercial $469.32
Rate for Payer: Cigna of WY Commercial $474.16
Rate for Payer: Entrust Commercial $459.65
Rate for Payer: First Choice Health Commercial $459.65
Rate for Payer: Government Employees Health Association (GEHA) Commercial $459.65
Rate for Payer: Government Employees Health Association (GEHA) Medicare $280.63
Rate for Payer: HealthUtah PPO $483.84
Rate for Payer: Idaho Integrated Healthcare Commercial $469.32
Rate for Payer: Multiplan Medicare/VA $266.60
Rate for Payer: One Health Plan of WY PPO $474.16
Rate for Payer: PacificSource Commercial $435.46
Rate for Payer: PHCS PPO $474.16
Rate for Payer: Three Rivers PPO $362.88
Rate for Payer: TriWest Veterans Administration $280.63
Rate for Payer: United Healthcare Commercial $420.94
Rate for Payer: United Healthcare Medicare $280.63
Rate for Payer: WINHealth Partners Commercial $474.16
Rate for Payer: Wise Provider Network Commercial $459.65
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $98.22
Max. Negotiated Rate $156.65
Rate for Payer: Aetna of WY Commercial/Medical Rental $153.52
Rate for Payer: Altius Auto/Workers Compensation $150.38
Rate for Payer: Altius Commercial $150.38
Rate for Payer: Beech Street Commercial $153.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $128.61
Rate for Payer: Cash Price $109.65
Rate for Payer: ChoiceCare Network Commercial $151.95
Rate for Payer: Cigna of WY Commercial $153.52
Rate for Payer: Entrust Commercial $148.82
Rate for Payer: First Choice Health Commercial $148.82
Rate for Payer: Government Employees Health Association (GEHA) Commercial $148.82
Rate for Payer: Government Employees Health Association (GEHA) Medicare $103.39
Rate for Payer: HealthUtah PPO $156.65
Rate for Payer: Idaho Integrated Healthcare Commercial $151.95
Rate for Payer: Multiplan Medicare/VA $98.22
Rate for Payer: One Health Plan of WY PPO $153.52
Rate for Payer: PacificSource Commercial $140.98
Rate for Payer: PHCS PPO $153.52
Rate for Payer: Three Rivers PPO $117.49
Rate for Payer: TriWest Veterans Administration $103.39
Rate for Payer: United Healthcare Commercial $136.29
Rate for Payer: United Healthcare Medicare $103.39
Rate for Payer: WINHealth Partners Commercial $148.82
Rate for Payer: Wise Provider Network Commercial $148.82
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $86.31
Max. Negotiated Rate $156.65
Rate for Payer: Aetna of WY Commercial/Medical Rental $153.52
Rate for Payer: Aetna of WY Medicare $103.39
Rate for Payer: Altius Auto/Workers Compensation $150.38
Rate for Payer: Altius Commercial $150.38
Rate for Payer: Beech Street Commercial $153.52
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $128.61
Rate for Payer: Cash Price $109.65
Rate for Payer: ChoiceCare Network Commercial $151.95
Rate for Payer: Cigna of WY Commercial $153.52
Rate for Payer: Entrust Commercial $148.82
Rate for Payer: First Choice Health Commercial $148.82
Rate for Payer: Government Employees Health Association (GEHA) Commercial $148.82
Rate for Payer: Government Employees Health Association (GEHA) Medicare $90.86
Rate for Payer: HealthUtah PPO $156.65
Rate for Payer: Idaho Integrated Healthcare Commercial $151.95
Rate for Payer: Multiplan Medicare/VA $86.31
Rate for Payer: One Health Plan of WY PPO $153.52
Rate for Payer: PacificSource Commercial $140.98
Rate for Payer: PHCS PPO $153.52
Rate for Payer: Three Rivers PPO $117.49
Rate for Payer: TriWest Veterans Administration $90.86
Rate for Payer: United Healthcare Commercial $136.29
Rate for Payer: United Healthcare Medicare $90.86
Rate for Payer: WINHealth Partners Commercial $153.52
Rate for Payer: Wise Provider Network Commercial $148.82
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $21.76
Max. Negotiated Rate $39.49
Rate for Payer: Aetna of WY Commercial/Medical Rental $38.70
Rate for Payer: Aetna of WY Medicare $26.06
Rate for Payer: Altius Auto/Workers Compensation $37.91
Rate for Payer: Altius Commercial $37.91
Rate for Payer: Beech Street Commercial $38.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $32.42
Rate for Payer: Cash Price $27.65
Rate for Payer: ChoiceCare Network Commercial $38.31
Rate for Payer: Cigna of WY Commercial $38.70
Rate for Payer: Entrust Commercial $37.52
Rate for Payer: First Choice Health Commercial $37.52
Rate for Payer: Government Employees Health Association (GEHA) Commercial $37.52
Rate for Payer: Government Employees Health Association (GEHA) Medicare $22.90
Rate for Payer: HealthUtah PPO $39.49
Rate for Payer: Idaho Integrated Healthcare Commercial $38.31
Rate for Payer: Multiplan Medicare/VA $21.76
Rate for Payer: One Health Plan of WY PPO $38.70
Rate for Payer: PacificSource Commercial $35.54
Rate for Payer: PHCS PPO $38.70
Rate for Payer: Three Rivers PPO $29.62
Rate for Payer: TriWest Veterans Administration $22.90
Rate for Payer: United Healthcare Commercial $34.36
Rate for Payer: United Healthcare Medicare $22.90
Rate for Payer: WINHealth Partners Commercial $38.70
Rate for Payer: Wise Provider Network Commercial $37.52
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $24.76
Max. Negotiated Rate $39.49
Rate for Payer: Aetna of WY Commercial/Medical Rental $38.70
Rate for Payer: Altius Auto/Workers Compensation $37.91
Rate for Payer: Altius Commercial $37.91
Rate for Payer: Beech Street Commercial $38.70
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $32.42
Rate for Payer: Cash Price $27.65
Rate for Payer: ChoiceCare Network Commercial $38.31
Rate for Payer: Cigna of WY Commercial $38.70
Rate for Payer: Entrust Commercial $37.52
Rate for Payer: First Choice Health Commercial $37.52
Rate for Payer: Government Employees Health Association (GEHA) Commercial $37.52
Rate for Payer: Government Employees Health Association (GEHA) Medicare $26.06
Rate for Payer: HealthUtah PPO $39.49
Rate for Payer: Idaho Integrated Healthcare Commercial $38.31
Rate for Payer: Multiplan Medicare/VA $24.76
Rate for Payer: One Health Plan of WY PPO $38.70
Rate for Payer: PacificSource Commercial $35.54
Rate for Payer: PHCS PPO $38.70
Rate for Payer: Three Rivers PPO $29.62
Rate for Payer: TriWest Veterans Administration $26.06
Rate for Payer: United Healthcare Commercial $34.36
Rate for Payer: United Healthcare Medicare $26.06
Rate for Payer: WINHealth Partners Commercial $37.52
Rate for Payer: Wise Provider Network Commercial $37.52
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $170.64
Max. Negotiated Rate $272.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $266.72
Rate for Payer: Altius Auto/Workers Compensation $261.27
Rate for Payer: Altius Commercial $261.27
Rate for Payer: Beech Street Commercial $266.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $223.44
Rate for Payer: Cash Price $190.51
Rate for Payer: ChoiceCare Network Commercial $264.00
Rate for Payer: Cigna of WY Commercial $266.72
Rate for Payer: Entrust Commercial $258.55
Rate for Payer: First Choice Health Commercial $258.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $258.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $179.63
Rate for Payer: HealthUtah PPO $272.16
Rate for Payer: Idaho Integrated Healthcare Commercial $264.00
Rate for Payer: Multiplan Medicare/VA $170.64
Rate for Payer: One Health Plan of WY PPO $266.72
Rate for Payer: PacificSource Commercial $244.94
Rate for Payer: PHCS PPO $266.72
Rate for Payer: Three Rivers PPO $204.12
Rate for Payer: TriWest Veterans Administration $179.63
Rate for Payer: United Healthcare Commercial $236.78
Rate for Payer: United Healthcare Medicare $179.63
Rate for Payer: WINHealth Partners Commercial $258.55
Rate for Payer: Wise Provider Network Commercial $258.55
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $149.96
Max. Negotiated Rate $272.16
Rate for Payer: Aetna of WY Commercial/Medical Rental $266.72
Rate for Payer: Aetna of WY Medicare $179.63
Rate for Payer: Altius Auto/Workers Compensation $261.27
Rate for Payer: Altius Commercial $261.27
Rate for Payer: Beech Street Commercial $266.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $223.44
Rate for Payer: Cash Price $190.51
Rate for Payer: ChoiceCare Network Commercial $264.00
Rate for Payer: Cigna of WY Commercial $266.72
Rate for Payer: Entrust Commercial $258.55
Rate for Payer: First Choice Health Commercial $258.55
Rate for Payer: Government Employees Health Association (GEHA) Commercial $258.55
Rate for Payer: Government Employees Health Association (GEHA) Medicare $157.85
Rate for Payer: HealthUtah PPO $272.16
Rate for Payer: Idaho Integrated Healthcare Commercial $264.00
Rate for Payer: Multiplan Medicare/VA $149.96
Rate for Payer: One Health Plan of WY PPO $266.72
Rate for Payer: PacificSource Commercial $244.94
Rate for Payer: PHCS PPO $266.72
Rate for Payer: Three Rivers PPO $204.12
Rate for Payer: TriWest Veterans Administration $157.85
Rate for Payer: United Healthcare Commercial $236.78
Rate for Payer: United Healthcare Medicare $157.85
Rate for Payer: WINHealth Partners Commercial $266.72
Rate for Payer: Wise Provider Network Commercial $258.55
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $71.50
Max. Negotiated Rate $114.03
Rate for Payer: Aetna of WY Commercial/Medical Rental $111.75
Rate for Payer: Altius Auto/Workers Compensation $109.47
Rate for Payer: Altius Commercial $109.47
Rate for Payer: Beech Street Commercial $111.75
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $93.62
Rate for Payer: Cash Price $79.82
Rate for Payer: ChoiceCare Network Commercial $110.61
Rate for Payer: Cigna of WY Commercial $111.75
Rate for Payer: Entrust Commercial $108.33
Rate for Payer: First Choice Health Commercial $108.33
Rate for Payer: Government Employees Health Association (GEHA) Commercial $108.33
Rate for Payer: Government Employees Health Association (GEHA) Medicare $75.26
Rate for Payer: HealthUtah PPO $114.03
Rate for Payer: Idaho Integrated Healthcare Commercial $110.61
Rate for Payer: Multiplan Medicare/VA $71.50
Rate for Payer: One Health Plan of WY PPO $111.75
Rate for Payer: PacificSource Commercial $102.63
Rate for Payer: PHCS PPO $111.75
Rate for Payer: Three Rivers PPO $85.52
Rate for Payer: TriWest Veterans Administration $75.26
Rate for Payer: United Healthcare Commercial $99.21
Rate for Payer: United Healthcare Medicare $75.26
Rate for Payer: WINHealth Partners Commercial $108.33
Rate for Payer: Wise Provider Network Commercial $108.33
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $62.83
Max. Negotiated Rate $114.03
Rate for Payer: Aetna of WY Commercial/Medical Rental $111.75
Rate for Payer: Aetna of WY Medicare $75.26
Rate for Payer: Altius Auto/Workers Compensation $109.47
Rate for Payer: Altius Commercial $109.47
Rate for Payer: Beech Street Commercial $111.75
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $93.62
Rate for Payer: Cash Price $79.82
Rate for Payer: ChoiceCare Network Commercial $110.61
Rate for Payer: Cigna of WY Commercial $111.75
Rate for Payer: Entrust Commercial $108.33
Rate for Payer: First Choice Health Commercial $108.33
Rate for Payer: Government Employees Health Association (GEHA) Commercial $108.33
Rate for Payer: Government Employees Health Association (GEHA) Medicare $66.14
Rate for Payer: HealthUtah PPO $114.03
Rate for Payer: Idaho Integrated Healthcare Commercial $110.61
Rate for Payer: Multiplan Medicare/VA $62.83
Rate for Payer: One Health Plan of WY PPO $111.75
Rate for Payer: PacificSource Commercial $102.63
Rate for Payer: PHCS PPO $111.75
Rate for Payer: Three Rivers PPO $85.52
Rate for Payer: TriWest Veterans Administration $66.14
Rate for Payer: United Healthcare Commercial $99.21
Rate for Payer: United Healthcare Medicare $66.14
Rate for Payer: WINHealth Partners Commercial $111.75
Rate for Payer: Wise Provider Network Commercial $108.33
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $62.25
Max. Negotiated Rate $112.98
Rate for Payer: Aetna of WY Commercial/Medical Rental $110.72
Rate for Payer: Aetna of WY Medicare $74.57
Rate for Payer: Altius Auto/Workers Compensation $108.46
Rate for Payer: Altius Commercial $108.46
Rate for Payer: Beech Street Commercial $110.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $92.76
Rate for Payer: Cash Price $79.09
Rate for Payer: ChoiceCare Network Commercial $109.59
Rate for Payer: Cigna of WY Commercial $110.72
Rate for Payer: Entrust Commercial $107.33
Rate for Payer: First Choice Health Commercial $107.33
Rate for Payer: Government Employees Health Association (GEHA) Commercial $107.33
Rate for Payer: Government Employees Health Association (GEHA) Medicare $65.53
Rate for Payer: HealthUtah PPO $112.98
Rate for Payer: Idaho Integrated Healthcare Commercial $109.59
Rate for Payer: Multiplan Medicare/VA $62.25
Rate for Payer: One Health Plan of WY PPO $110.72
Rate for Payer: PacificSource Commercial $101.68
Rate for Payer: PHCS PPO $110.72
Rate for Payer: Three Rivers PPO $84.74
Rate for Payer: TriWest Veterans Administration $65.53
Rate for Payer: United Healthcare Commercial $98.29
Rate for Payer: United Healthcare Medicare $65.53
Rate for Payer: WINHealth Partners Commercial $110.72
Rate for Payer: Wise Provider Network Commercial $107.33
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $70.84
Max. Negotiated Rate $112.98
Rate for Payer: Aetna of WY Commercial/Medical Rental $110.72
Rate for Payer: Altius Auto/Workers Compensation $108.46
Rate for Payer: Altius Commercial $108.46
Rate for Payer: Beech Street Commercial $110.72
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $92.76
Rate for Payer: Cash Price $79.09
Rate for Payer: ChoiceCare Network Commercial $109.59
Rate for Payer: Cigna of WY Commercial $110.72
Rate for Payer: Entrust Commercial $107.33
Rate for Payer: First Choice Health Commercial $107.33
Rate for Payer: Government Employees Health Association (GEHA) Commercial $107.33
Rate for Payer: Government Employees Health Association (GEHA) Medicare $74.57
Rate for Payer: HealthUtah PPO $112.98
Rate for Payer: Idaho Integrated Healthcare Commercial $109.59
Rate for Payer: Multiplan Medicare/VA $70.84
Rate for Payer: One Health Plan of WY PPO $110.72
Rate for Payer: PacificSource Commercial $101.68
Rate for Payer: PHCS PPO $110.72
Rate for Payer: Three Rivers PPO $84.74
Rate for Payer: TriWest Veterans Administration $74.57
Rate for Payer: United Healthcare Commercial $98.29
Rate for Payer: United Healthcare Medicare $74.57
Rate for Payer: WINHealth Partners Commercial $107.33
Rate for Payer: Wise Provider Network Commercial $107.33
Service Code NDC 0904608261
Hospital Revenue Code 250
Min. Negotiated Rate $0.19
Max. Negotiated Rate $0.35
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.34
Rate for Payer: Aetna of WY Medicare $0.23
Rate for Payer: Altius Auto/Workers Compensation $0.34
Rate for Payer: Altius Commercial $0.34
Rate for Payer: Beech Street Commercial $0.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.29
Rate for Payer: Cash Price $0.24
Rate for Payer: ChoiceCare Network Commercial $0.34
Rate for Payer: Cigna of WY Commercial $0.34
Rate for Payer: Entrust Commercial $0.33
Rate for Payer: First Choice Health Commercial $0.33
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.33
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.20
Rate for Payer: HealthUtah PPO $0.35
Rate for Payer: Idaho Integrated Healthcare Commercial $0.34
Rate for Payer: Multiplan Medicare/VA $0.19
Rate for Payer: One Health Plan of WY PPO $0.34
Rate for Payer: PacificSource Commercial $0.32
Rate for Payer: PHCS PPO $0.34
Rate for Payer: Three Rivers PPO $0.26
Rate for Payer: TriWest Veterans Administration $0.20
Rate for Payer: United Healthcare Commercial $0.30
Rate for Payer: United Healthcare Medicare $0.20
Rate for Payer: WINHealth Partners Commercial $0.34
Rate for Payer: Wise Provider Network Commercial $0.33
Service Code NDC 6808418911
Hospital Revenue Code 250
Min. Negotiated Rate $0.31
Max. Negotiated Rate $0.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.49
Rate for Payer: Altius Auto/Workers Compensation $0.48
Rate for Payer: Altius Commercial $0.48
Rate for Payer: Beech Street Commercial $0.49
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.41
Rate for Payer: Cash Price $0.35
Rate for Payer: ChoiceCare Network Commercial $0.49
Rate for Payer: Cigna of WY Commercial $0.49
Rate for Payer: Entrust Commercial $0.48
Rate for Payer: First Choice Health Commercial $0.48
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.48
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.33
Rate for Payer: HealthUtah PPO $0.50
Rate for Payer: Idaho Integrated Healthcare Commercial $0.49
Rate for Payer: Multiplan Medicare/VA $0.31
Rate for Payer: One Health Plan of WY PPO $0.49
Rate for Payer: PacificSource Commercial $0.45
Rate for Payer: PHCS PPO $0.49
Rate for Payer: Three Rivers PPO $0.38
Rate for Payer: TriWest Veterans Administration $0.33
Rate for Payer: United Healthcare Commercial $0.44
Rate for Payer: United Healthcare Medicare $0.33
Rate for Payer: WINHealth Partners Commercial $0.48
Rate for Payer: Wise Provider Network Commercial $0.48
Service Code NDC 6808418911
Hospital Revenue Code 250
Min. Negotiated Rate $0.28
Max. Negotiated Rate $0.50
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.49
Rate for Payer: Aetna of WY Medicare $0.33
Rate for Payer: Altius Auto/Workers Compensation $0.48
Rate for Payer: Altius Commercial $0.48
Rate for Payer: Beech Street Commercial $0.49
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.41
Rate for Payer: Cash Price $0.35
Rate for Payer: ChoiceCare Network Commercial $0.49
Rate for Payer: Cigna of WY Commercial $0.49
Rate for Payer: Entrust Commercial $0.48
Rate for Payer: First Choice Health Commercial $0.48
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.48
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.29
Rate for Payer: HealthUtah PPO $0.50
Rate for Payer: Idaho Integrated Healthcare Commercial $0.49
Rate for Payer: Multiplan Medicare/VA $0.28
Rate for Payer: One Health Plan of WY PPO $0.49
Rate for Payer: PacificSource Commercial $0.45
Rate for Payer: PHCS PPO $0.49
Rate for Payer: Three Rivers PPO $0.38
Rate for Payer: TriWest Veterans Administration $0.29
Rate for Payer: United Healthcare Commercial $0.44
Rate for Payer: United Healthcare Medicare $0.29
Rate for Payer: WINHealth Partners Commercial $0.49
Rate for Payer: Wise Provider Network Commercial $0.48
Service Code NDC 0904608261
Hospital Revenue Code 250
Min. Negotiated Rate $0.22
Max. Negotiated Rate $0.35
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.34
Rate for Payer: Altius Auto/Workers Compensation $0.34
Rate for Payer: Altius Commercial $0.34
Rate for Payer: Beech Street Commercial $0.34
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.29
Rate for Payer: Cash Price $0.24
Rate for Payer: ChoiceCare Network Commercial $0.34
Rate for Payer: Cigna of WY Commercial $0.34
Rate for Payer: Entrust Commercial $0.33
Rate for Payer: First Choice Health Commercial $0.33
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.33
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.23
Rate for Payer: HealthUtah PPO $0.35
Rate for Payer: Idaho Integrated Healthcare Commercial $0.34
Rate for Payer: Multiplan Medicare/VA $0.22
Rate for Payer: One Health Plan of WY PPO $0.34
Rate for Payer: PacificSource Commercial $0.32
Rate for Payer: PHCS PPO $0.34
Rate for Payer: Three Rivers PPO $0.26
Rate for Payer: TriWest Veterans Administration $0.23
Rate for Payer: United Healthcare Commercial $0.30
Rate for Payer: United Healthcare Medicare $0.23
Rate for Payer: WINHealth Partners Commercial $0.33
Rate for Payer: Wise Provider Network Commercial $0.33