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Charge Type Setting Price  
Service Code NDC 4733530788
Hospital Revenue Code 250
Min. Negotiated Rate $0.63
Max. Negotiated Rate $1.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.98
Rate for Payer: Altius Auto/Workers Compensation $0.96
Rate for Payer: Altius Commercial $0.96
Rate for Payer: Beech Street Commercial $0.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.82
Rate for Payer: Cash Price $0.70
Rate for Payer: ChoiceCare Network Commercial $0.97
Rate for Payer: Cigna of WY Commercial $0.98
Rate for Payer: Entrust Commercial $0.95
Rate for Payer: First Choice Health Commercial $0.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.66
Rate for Payer: HealthUtah PPO $1.00
Rate for Payer: Idaho Integrated Healthcare Commercial $0.97
Rate for Payer: Multiplan Medicare/VA $0.63
Rate for Payer: One Health Plan of WY PPO $0.98
Rate for Payer: PacificSource Commercial $0.90
Rate for Payer: PHCS PPO $0.98
Rate for Payer: Three Rivers PPO $0.75
Rate for Payer: TriWest Veterans Administration $0.66
Rate for Payer: United Healthcare Commercial $0.87
Rate for Payer: United Healthcare Medicare $0.66
Rate for Payer: WINHealth Partners Commercial $0.95
Rate for Payer: Wise Provider Network Commercial $0.95
Service Code NDC 4733530788
Hospital Revenue Code 250
Min. Negotiated Rate $0.55
Max. Negotiated Rate $1.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.98
Rate for Payer: Aetna of WY Medicare $0.66
Rate for Payer: Altius Auto/Workers Compensation $0.96
Rate for Payer: Altius Commercial $0.96
Rate for Payer: Beech Street Commercial $0.98
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.82
Rate for Payer: Cash Price $0.70
Rate for Payer: ChoiceCare Network Commercial $0.97
Rate for Payer: Cigna of WY Commercial $0.98
Rate for Payer: Entrust Commercial $0.95
Rate for Payer: First Choice Health Commercial $0.95
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.95
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.58
Rate for Payer: HealthUtah PPO $1.00
Rate for Payer: Idaho Integrated Healthcare Commercial $0.97
Rate for Payer: Multiplan Medicare/VA $0.55
Rate for Payer: One Health Plan of WY PPO $0.98
Rate for Payer: PacificSource Commercial $0.90
Rate for Payer: PHCS PPO $0.98
Rate for Payer: Three Rivers PPO $0.75
Rate for Payer: TriWest Veterans Administration $0.58
Rate for Payer: United Healthcare Commercial $0.87
Rate for Payer: United Healthcare Medicare $0.58
Rate for Payer: WINHealth Partners Commercial $0.98
Rate for Payer: Wise Provider Network Commercial $0.95
Service Code HCPCS 90736
Hospital Charge Code 90736
Min. Negotiated Rate $260.25
Max. Negotiated Rate $347.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $340.06
Rate for Payer: Beech Street Commercial $329.65
Rate for Payer: Cash Price $242.90
Rate for Payer: ChoiceCare Network Commercial $336.59
Rate for Payer: Cigna of WY Commercial $340.06
Rate for Payer: First Choice Health Commercial $312.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $329.65
Rate for Payer: HealthUtah PPO $347.00
Rate for Payer: Idaho Integrated Healthcare Commercial $336.59
Rate for Payer: One Health Plan of WY PPO $340.06
Rate for Payer: PacificSource Commercial $312.30
Rate for Payer: PHCS PPO $329.65
Rate for Payer: Three Rivers PPO $260.25
Rate for Payer: United Healthcare Commercial $301.89
Rate for Payer: WINHealth Partners Commercial $347.00