Price Transparency

Know your out-of-pocket cost for care.

search
Charge Type Setting Price  
Hospital Charge Code 3004640
Hospital Revenue Code 278
Min. Negotiated Rate $8,113.00
Max. Negotiated Rate $14,000.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $13,720.00
Rate for Payer: Aetna of WY Medicare $8,960.00
Rate for Payer: Altius Commercial $13,440.00
Rate for Payer: Beech Street Commercial $13,720.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $13,580.00
Rate for Payer: Cash Price $9,800.00
Rate for Payer: ChoiceCare Network Commercial $13,580.00
Rate for Payer: Cigna of WY Commercial $13,720.00
Rate for Payer: Entrust Commercial $13,300.00
Rate for Payer: First Choice Health Commercial $13,300.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $13,300.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8,540.00
Rate for Payer: HealthUtah PPO $14,000.00
Rate for Payer: Idaho Integrated Healthcare Commercial $13,580.00
Rate for Payer: Multiplan Medicare/VA $8,113.00
Rate for Payer: One Health Plan of WY PPO $13,720.00
Rate for Payer: PacificSource Commercial $12,600.00
Rate for Payer: PHCS PPO $13,720.00
Rate for Payer: Three Rivers PPO $10,500.00
Rate for Payer: TriWest Veterans Administration $8,540.00
Rate for Payer: United Healthcare Commercial $13,370.00
Rate for Payer: United Healthcare Medicare $8,540.00
Rate for Payer: WINHealth Partners Commercial $13,300.00
Rate for Payer: Wise Provider Network Commercial $13,300.00
Service Code HCPCS J0630
Hospital Revenue Code 636
Min. Negotiated Rate $17.20
Max. Negotiated Rate $29.68
Rate for Payer: Aetna of WY Commercial/Medical Rental $29.09
Rate for Payer: Aetna of WY Medicare $19.00
Rate for Payer: Altius Commercial $28.49
Rate for Payer: Beech Street Commercial $29.09
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $28.79
Rate for Payer: Cash Price $20.77
Rate for Payer: ChoiceCare Network Commercial $28.79
Rate for Payer: Cigna of WY Commercial $29.09
Rate for Payer: Entrust Commercial $28.20
Rate for Payer: First Choice Health Commercial $28.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $28.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $18.10
Rate for Payer: HealthUtah PPO $29.68
Rate for Payer: Idaho Integrated Healthcare Commercial $28.79
Rate for Payer: Multiplan Medicare/VA $17.20
Rate for Payer: One Health Plan of WY PPO $29.09
Rate for Payer: PacificSource Commercial $26.71
Rate for Payer: PHCS PPO $29.09
Rate for Payer: Three Rivers PPO $22.26
Rate for Payer: TriWest Veterans Administration $18.10
Rate for Payer: United Healthcare Commercial $28.34
Rate for Payer: United Healthcare Medicare $18.10
Rate for Payer: WINHealth Partners Commercial $28.20
Rate for Payer: Wise Provider Network Commercial $28.20
Service Code HCPCS J0630
Hospital Revenue Code 636
Min. Negotiated Rate $16.07
Max. Negotiated Rate $29.68
Rate for Payer: Aetna of WY Commercial/Medical Rental $29.09
Rate for Payer: Aetna of WY Medicare $19.59
Rate for Payer: Altius Commercial $28.49
Rate for Payer: Beech Street Commercial $29.09
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $28.79
Rate for Payer: Cash Price $20.77
Rate for Payer: ChoiceCare Network Commercial $28.79
Rate for Payer: Cigna of WY Commercial $29.09
Rate for Payer: Entrust Commercial $28.20
Rate for Payer: First Choice Health Commercial $28.20
Rate for Payer: Government Employees Health Association (GEHA) Commercial $28.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $16.92
Rate for Payer: HealthUtah PPO $29.68
Rate for Payer: Idaho Integrated Healthcare Commercial $28.79
Rate for Payer: Multiplan Medicare/VA $16.07
Rate for Payer: One Health Plan of WY PPO $29.09
Rate for Payer: PacificSource Commercial $26.71
Rate for Payer: PHCS PPO $29.09
Rate for Payer: Three Rivers PPO $22.26
Rate for Payer: TriWest Veterans Administration $16.92
Rate for Payer: United Healthcare Commercial $28.34
Rate for Payer: United Healthcare Medicare $16.92
Rate for Payer: WINHealth Partners Commercial $29.09
Rate for Payer: Wise Provider Network Commercial $28.20
Service Code NDC 6068734511
Hospital Revenue Code 250
Min. Negotiated Rate $10.40
Max. Negotiated Rate $17.95
Rate for Payer: WINHealth Partners Commercial $17.05
Rate for Payer: Aetna of WY Commercial/Medical Rental $17.59
Rate for Payer: Aetna of WY Medicare $11.49
Rate for Payer: Altius Commercial $17.23
Rate for Payer: Beech Street Commercial $17.59
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $17.41
Rate for Payer: Cash Price $12.57
Rate for Payer: ChoiceCare Network Commercial $17.41
Rate for Payer: Cigna of WY Commercial $17.59
Rate for Payer: Entrust Commercial $17.05
Rate for Payer: First Choice Health Commercial $17.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $17.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.95
Rate for Payer: HealthUtah PPO $17.95
Rate for Payer: Idaho Integrated Healthcare Commercial $17.41
Rate for Payer: Multiplan Medicare/VA $10.40
Rate for Payer: One Health Plan of WY PPO $17.59
Rate for Payer: PacificSource Commercial $16.16
Rate for Payer: PHCS PPO $17.59
Rate for Payer: Three Rivers PPO $13.46
Rate for Payer: TriWest Veterans Administration $10.95
Rate for Payer: United Healthcare Commercial $17.14
Rate for Payer: United Healthcare Medicare $10.95
Rate for Payer: Wise Provider Network Commercial $17.05
Service Code NDC 6068734511
Hospital Revenue Code 250
Min. Negotiated Rate $9.72
Max. Negotiated Rate $17.95
Rate for Payer: Aetna of WY Commercial/Medical Rental $17.59
Rate for Payer: Aetna of WY Medicare $11.85
Rate for Payer: Altius Commercial $17.23
Rate for Payer: Beech Street Commercial $17.59
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $17.41
Rate for Payer: Cash Price $12.57
Rate for Payer: ChoiceCare Network Commercial $17.41
Rate for Payer: Cigna of WY Commercial $17.59
Rate for Payer: Entrust Commercial $17.05
Rate for Payer: First Choice Health Commercial $17.05
Rate for Payer: Government Employees Health Association (GEHA) Commercial $17.05
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.23
Rate for Payer: HealthUtah PPO $17.95
Rate for Payer: Idaho Integrated Healthcare Commercial $17.41
Rate for Payer: Multiplan Medicare/VA $9.72
Rate for Payer: One Health Plan of WY PPO $17.59
Rate for Payer: PacificSource Commercial $16.16
Rate for Payer: PHCS PPO $17.59
Rate for Payer: Three Rivers PPO $13.46
Rate for Payer: TriWest Veterans Administration $10.23
Rate for Payer: United Healthcare Commercial $17.14
Rate for Payer: United Healthcare Medicare $10.23
Rate for Payer: WINHealth Partners Commercial $17.59
Rate for Payer: Wise Provider Network Commercial $17.05
Service Code NDC 6655300401
Hospital Revenue Code 250
Min. Negotiated Rate $8.82
Max. Negotiated Rate $15.22
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.92
Rate for Payer: Aetna of WY Medicare $9.74
Rate for Payer: Altius Commercial $14.61
Rate for Payer: Beech Street Commercial $14.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.76
Rate for Payer: Cash Price $10.66
Rate for Payer: ChoiceCare Network Commercial $14.76
Rate for Payer: Cigna of WY Commercial $14.92
Rate for Payer: Entrust Commercial $14.46
Rate for Payer: First Choice Health Commercial $14.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.46
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.28
Rate for Payer: HealthUtah PPO $15.22
Rate for Payer: Idaho Integrated Healthcare Commercial $14.76
Rate for Payer: Multiplan Medicare/VA $8.82
Rate for Payer: One Health Plan of WY PPO $14.92
Rate for Payer: PacificSource Commercial $13.70
Rate for Payer: PHCS PPO $14.92
Rate for Payer: Three Rivers PPO $11.42
Rate for Payer: TriWest Veterans Administration $9.28
Rate for Payer: United Healthcare Commercial $14.54
Rate for Payer: United Healthcare Medicare $9.28
Rate for Payer: WINHealth Partners Commercial $14.46
Rate for Payer: Wise Provider Network Commercial $14.46
Service Code NDC 6655300401
Hospital Revenue Code 250
Min. Negotiated Rate $8.24
Max. Negotiated Rate $15.22
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.92
Rate for Payer: Aetna of WY Medicare $10.05
Rate for Payer: Altius Commercial $14.61
Rate for Payer: Beech Street Commercial $14.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.76
Rate for Payer: Cash Price $10.66
Rate for Payer: ChoiceCare Network Commercial $14.76
Rate for Payer: Cigna of WY Commercial $14.92
Rate for Payer: Entrust Commercial $14.46
Rate for Payer: First Choice Health Commercial $14.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.46
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.68
Rate for Payer: HealthUtah PPO $15.22
Rate for Payer: Idaho Integrated Healthcare Commercial $14.76
Rate for Payer: Multiplan Medicare/VA $8.24
Rate for Payer: One Health Plan of WY PPO $14.92
Rate for Payer: PacificSource Commercial $13.70
Rate for Payer: PHCS PPO $14.92
Rate for Payer: Three Rivers PPO $11.42
Rate for Payer: TriWest Veterans Administration $8.68
Rate for Payer: United Healthcare Commercial $14.54
Rate for Payer: United Healthcare Medicare $8.68
Rate for Payer: WINHealth Partners Commercial $14.92
Rate for Payer: Wise Provider Network Commercial $14.46
Service Code NDC 3680088124
Hospital Revenue Code 250
Min. Negotiated Rate $8.82
Max. Negotiated Rate $15.22
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.92
Rate for Payer: Aetna of WY Medicare $9.74
Rate for Payer: Altius Commercial $14.61
Rate for Payer: Beech Street Commercial $14.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.76
Rate for Payer: Cash Price $10.65
Rate for Payer: ChoiceCare Network Commercial $14.76
Rate for Payer: Cigna of WY Commercial $14.92
Rate for Payer: Entrust Commercial $14.46
Rate for Payer: First Choice Health Commercial $14.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.46
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.28
Rate for Payer: HealthUtah PPO $15.22
Rate for Payer: Idaho Integrated Healthcare Commercial $14.76
Rate for Payer: Multiplan Medicare/VA $8.82
Rate for Payer: One Health Plan of WY PPO $14.92
Rate for Payer: PacificSource Commercial $13.70
Rate for Payer: PHCS PPO $14.92
Rate for Payer: Three Rivers PPO $11.42
Rate for Payer: TriWest Veterans Administration $9.28
Rate for Payer: United Healthcare Commercial $14.54
Rate for Payer: United Healthcare Medicare $9.28
Rate for Payer: WINHealth Partners Commercial $14.46
Rate for Payer: Wise Provider Network Commercial $14.46
Service Code NDC 8770143612
Hospital Revenue Code 250
Min. Negotiated Rate $8.78
Max. Negotiated Rate $15.15
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.85
Rate for Payer: Aetna of WY Medicare $9.70
Rate for Payer: Altius Commercial $14.54
Rate for Payer: Beech Street Commercial $14.85
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.70
Rate for Payer: Cash Price $10.61
Rate for Payer: ChoiceCare Network Commercial $14.70
Rate for Payer: Cigna of WY Commercial $14.85
Rate for Payer: Entrust Commercial $14.39
Rate for Payer: First Choice Health Commercial $14.39
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.39
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.24
Rate for Payer: HealthUtah PPO $15.15
Rate for Payer: Idaho Integrated Healthcare Commercial $14.70
Rate for Payer: Multiplan Medicare/VA $8.78
Rate for Payer: One Health Plan of WY PPO $14.85
Rate for Payer: PacificSource Commercial $13.64
Rate for Payer: PHCS PPO $14.85
Rate for Payer: Three Rivers PPO $11.36
Rate for Payer: TriWest Veterans Administration $9.24
Rate for Payer: United Healthcare Commercial $14.47
Rate for Payer: United Healthcare Medicare $9.24
Rate for Payer: WINHealth Partners Commercial $14.39
Rate for Payer: Wise Provider Network Commercial $14.39
Service Code NDC 2438559523
Hospital Revenue Code 250
Min. Negotiated Rate $8.78
Max. Negotiated Rate $15.15
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.85
Rate for Payer: Aetna of WY Medicare $9.70
Rate for Payer: Altius Commercial $14.54
Rate for Payer: Beech Street Commercial $14.85
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.70
Rate for Payer: Cash Price $10.61
Rate for Payer: ChoiceCare Network Commercial $14.70
Rate for Payer: Cigna of WY Commercial $14.85
Rate for Payer: Entrust Commercial $14.39
Rate for Payer: First Choice Health Commercial $14.39
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.39
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.24
Rate for Payer: HealthUtah PPO $15.15
Rate for Payer: Idaho Integrated Healthcare Commercial $14.70
Rate for Payer: Multiplan Medicare/VA $8.78
Rate for Payer: One Health Plan of WY PPO $14.85
Rate for Payer: PacificSource Commercial $13.64
Rate for Payer: PHCS PPO $14.85
Rate for Payer: Three Rivers PPO $11.36
Rate for Payer: TriWest Veterans Administration $9.24
Rate for Payer: United Healthcare Commercial $14.47
Rate for Payer: United Healthcare Medicare $9.24
Rate for Payer: WINHealth Partners Commercial $14.39
Rate for Payer: Wise Provider Network Commercial $14.39
Service Code NDC 2438559523
Hospital Revenue Code 250
Min. Negotiated Rate $8.20
Max. Negotiated Rate $15.15
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.85
Rate for Payer: Aetna of WY Medicare $10.00
Rate for Payer: Altius Commercial $14.54
Rate for Payer: Beech Street Commercial $14.85
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.70
Rate for Payer: Cash Price $10.61
Rate for Payer: ChoiceCare Network Commercial $14.70
Rate for Payer: Cigna of WY Commercial $14.85
Rate for Payer: Entrust Commercial $14.39
Rate for Payer: First Choice Health Commercial $14.39
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.39
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.64
Rate for Payer: HealthUtah PPO $15.15
Rate for Payer: Idaho Integrated Healthcare Commercial $14.70
Rate for Payer: Multiplan Medicare/VA $8.20
Rate for Payer: One Health Plan of WY PPO $14.85
Rate for Payer: PacificSource Commercial $13.64
Rate for Payer: PHCS PPO $14.85
Rate for Payer: Three Rivers PPO $11.36
Rate for Payer: TriWest Veterans Administration $8.64
Rate for Payer: United Healthcare Commercial $14.47
Rate for Payer: United Healthcare Medicare $8.64
Rate for Payer: WINHealth Partners Commercial $14.85
Rate for Payer: Wise Provider Network Commercial $14.39
Service Code NDC 3680088124
Hospital Revenue Code 250
Min. Negotiated Rate $8.24
Max. Negotiated Rate $15.22
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.92
Rate for Payer: Aetna of WY Medicare $10.05
Rate for Payer: Altius Commercial $14.61
Rate for Payer: Beech Street Commercial $14.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.76
Rate for Payer: Cash Price $10.65
Rate for Payer: ChoiceCare Network Commercial $14.76
Rate for Payer: Cigna of WY Commercial $14.92
Rate for Payer: Entrust Commercial $14.46
Rate for Payer: First Choice Health Commercial $14.46
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.46
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.68
Rate for Payer: HealthUtah PPO $15.22
Rate for Payer: Idaho Integrated Healthcare Commercial $14.76
Rate for Payer: Multiplan Medicare/VA $8.24
Rate for Payer: One Health Plan of WY PPO $14.92
Rate for Payer: PacificSource Commercial $13.70
Rate for Payer: PHCS PPO $14.92
Rate for Payer: Three Rivers PPO $11.42
Rate for Payer: TriWest Veterans Administration $8.68
Rate for Payer: United Healthcare Commercial $14.54
Rate for Payer: United Healthcare Medicare $8.68
Rate for Payer: WINHealth Partners Commercial $14.92
Rate for Payer: Wise Provider Network Commercial $14.46
Service Code NDC 8770143612
Hospital Revenue Code 250
Min. Negotiated Rate $8.20
Max. Negotiated Rate $15.15
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.85
Rate for Payer: Aetna of WY Medicare $10.00
Rate for Payer: Altius Commercial $14.54
Rate for Payer: Beech Street Commercial $14.85
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.70
Rate for Payer: Cash Price $10.61
Rate for Payer: ChoiceCare Network Commercial $14.70
Rate for Payer: Cigna of WY Commercial $14.85
Rate for Payer: Entrust Commercial $14.39
Rate for Payer: First Choice Health Commercial $14.39
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.39
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.64
Rate for Payer: HealthUtah PPO $15.15
Rate for Payer: Idaho Integrated Healthcare Commercial $14.70
Rate for Payer: Multiplan Medicare/VA $8.20
Rate for Payer: One Health Plan of WY PPO $14.85
Rate for Payer: PacificSource Commercial $13.64
Rate for Payer: PHCS PPO $14.85
Rate for Payer: Three Rivers PPO $11.36
Rate for Payer: TriWest Veterans Administration $8.64
Rate for Payer: United Healthcare Commercial $14.47
Rate for Payer: United Healthcare Medicare $8.64
Rate for Payer: WINHealth Partners Commercial $14.85
Rate for Payer: Wise Provider Network Commercial $14.39
Service Code NDC 5707400177
Hospital Revenue Code 250
Min. Negotiated Rate $9.56
Max. Negotiated Rate $17.66
Rate for Payer: Aetna of WY Commercial/Medical Rental $17.31
Rate for Payer: Aetna of WY Medicare $11.66
Rate for Payer: Altius Commercial $16.95
Rate for Payer: Beech Street Commercial $17.31
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $17.13
Rate for Payer: Cash Price $12.36
Rate for Payer: ChoiceCare Network Commercial $17.13
Rate for Payer: Cigna of WY Commercial $17.31
Rate for Payer: Entrust Commercial $16.78
Rate for Payer: First Choice Health Commercial $16.78
Rate for Payer: Government Employees Health Association (GEHA) Commercial $16.78
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.07
Rate for Payer: HealthUtah PPO $17.66
Rate for Payer: Idaho Integrated Healthcare Commercial $17.13
Rate for Payer: Multiplan Medicare/VA $9.56
Rate for Payer: One Health Plan of WY PPO $17.31
Rate for Payer: PacificSource Commercial $15.89
Rate for Payer: PHCS PPO $17.31
Rate for Payer: Three Rivers PPO $13.24
Rate for Payer: TriWest Veterans Administration $10.07
Rate for Payer: United Healthcare Commercial $16.87
Rate for Payer: United Healthcare Medicare $10.07
Rate for Payer: WINHealth Partners Commercial $17.31
Rate for Payer: Wise Provider Network Commercial $16.78
Service Code NDC 1650002322
Hospital Revenue Code 250
Min. Negotiated Rate $9.92
Max. Negotiated Rate $17.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.78
Rate for Payer: Aetna of WY Medicare $10.96
Rate for Payer: Altius Commercial $16.44
Rate for Payer: Beech Street Commercial $16.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.61
Rate for Payer: Cash Price $11.98
Rate for Payer: ChoiceCare Network Commercial $16.61
Rate for Payer: Cigna of WY Commercial $16.78
Rate for Payer: Entrust Commercial $16.26
Rate for Payer: First Choice Health Commercial $16.26
Rate for Payer: Government Employees Health Association (GEHA) Commercial $16.26
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.44
Rate for Payer: HealthUtah PPO $17.12
Rate for Payer: Idaho Integrated Healthcare Commercial $16.61
Rate for Payer: Multiplan Medicare/VA $9.92
Rate for Payer: One Health Plan of WY PPO $16.78
Rate for Payer: PacificSource Commercial $15.41
Rate for Payer: PHCS PPO $16.78
Rate for Payer: Three Rivers PPO $12.84
Rate for Payer: TriWest Veterans Administration $10.44
Rate for Payer: United Healthcare Commercial $16.35
Rate for Payer: United Healthcare Medicare $10.44
Rate for Payer: WINHealth Partners Commercial $16.26
Rate for Payer: Wise Provider Network Commercial $16.26
Service Code NDC 5707400177
Hospital Revenue Code 250
Min. Negotiated Rate $10.23
Max. Negotiated Rate $17.66
Rate for Payer: Aetna of WY Commercial/Medical Rental $17.31
Rate for Payer: Aetna of WY Medicare $11.30
Rate for Payer: Altius Commercial $16.95
Rate for Payer: Beech Street Commercial $17.31
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $17.13
Rate for Payer: Cash Price $12.36
Rate for Payer: ChoiceCare Network Commercial $17.13
Rate for Payer: Cigna of WY Commercial $17.31
Rate for Payer: Entrust Commercial $16.78
Rate for Payer: First Choice Health Commercial $16.78
Rate for Payer: Government Employees Health Association (GEHA) Commercial $16.78
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.77
Rate for Payer: HealthUtah PPO $17.66
Rate for Payer: Idaho Integrated Healthcare Commercial $17.13
Rate for Payer: Multiplan Medicare/VA $10.23
Rate for Payer: One Health Plan of WY PPO $17.31
Rate for Payer: PacificSource Commercial $15.89
Rate for Payer: PHCS PPO $17.31
Rate for Payer: Three Rivers PPO $13.24
Rate for Payer: TriWest Veterans Administration $10.77
Rate for Payer: United Healthcare Commercial $16.87
Rate for Payer: United Healthcare Medicare $10.77
Rate for Payer: WINHealth Partners Commercial $16.78
Rate for Payer: Wise Provider Network Commercial $16.78
Service Code NDC 1650002322
Hospital Revenue Code 250
Min. Negotiated Rate $9.27
Max. Negotiated Rate $17.12
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.78
Rate for Payer: Aetna of WY Medicare $11.30
Rate for Payer: Altius Commercial $16.44
Rate for Payer: Beech Street Commercial $16.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.61
Rate for Payer: Cash Price $11.98
Rate for Payer: ChoiceCare Network Commercial $16.61
Rate for Payer: Cigna of WY Commercial $16.78
Rate for Payer: Entrust Commercial $16.26
Rate for Payer: First Choice Health Commercial $16.26
Rate for Payer: Government Employees Health Association (GEHA) Commercial $16.26
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.76
Rate for Payer: HealthUtah PPO $17.12
Rate for Payer: Idaho Integrated Healthcare Commercial $16.61
Rate for Payer: Multiplan Medicare/VA $9.27
Rate for Payer: One Health Plan of WY PPO $16.78
Rate for Payer: PacificSource Commercial $15.41
Rate for Payer: PHCS PPO $16.78
Rate for Payer: Three Rivers PPO $12.84
Rate for Payer: TriWest Veterans Administration $9.76
Rate for Payer: United Healthcare Commercial $16.35
Rate for Payer: United Healthcare Medicare $9.76
Rate for Payer: WINHealth Partners Commercial $16.78
Rate for Payer: Wise Provider Network Commercial $16.26
Service Code NDC 1000670038
Hospital Revenue Code 250
Min. Negotiated Rate $8.23
Max. Negotiated Rate $15.19
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.89
Rate for Payer: Aetna of WY Medicare $10.03
Rate for Payer: Altius Commercial $14.58
Rate for Payer: Beech Street Commercial $14.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.73
Rate for Payer: Cash Price $10.63
Rate for Payer: ChoiceCare Network Commercial $14.73
Rate for Payer: Cigna of WY Commercial $14.89
Rate for Payer: Entrust Commercial $14.43
Rate for Payer: First Choice Health Commercial $14.43
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.43
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.66
Rate for Payer: HealthUtah PPO $15.19
Rate for Payer: Idaho Integrated Healthcare Commercial $14.73
Rate for Payer: Multiplan Medicare/VA $8.23
Rate for Payer: One Health Plan of WY PPO $14.89
Rate for Payer: PacificSource Commercial $13.67
Rate for Payer: PHCS PPO $14.89
Rate for Payer: Three Rivers PPO $11.39
Rate for Payer: TriWest Veterans Administration $8.66
Rate for Payer: United Healthcare Commercial $14.51
Rate for Payer: United Healthcare Medicare $8.66
Rate for Payer: WINHealth Partners Commercial $14.89
Rate for Payer: Wise Provider Network Commercial $14.43
Service Code NDC 1000670038
Hospital Revenue Code 250
Min. Negotiated Rate $8.80
Max. Negotiated Rate $15.19
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.89
Rate for Payer: Aetna of WY Medicare $9.72
Rate for Payer: Altius Commercial $14.58
Rate for Payer: Beech Street Commercial $14.89
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.73
Rate for Payer: Cash Price $10.63
Rate for Payer: ChoiceCare Network Commercial $14.73
Rate for Payer: Cigna of WY Commercial $14.89
Rate for Payer: Entrust Commercial $14.43
Rate for Payer: First Choice Health Commercial $14.43
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.43
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.27
Rate for Payer: HealthUtah PPO $15.19
Rate for Payer: Idaho Integrated Healthcare Commercial $14.73
Rate for Payer: Multiplan Medicare/VA $8.80
Rate for Payer: One Health Plan of WY PPO $14.89
Rate for Payer: PacificSource Commercial $13.67
Rate for Payer: PHCS PPO $14.89
Rate for Payer: Three Rivers PPO $11.39
Rate for Payer: TriWest Veterans Administration $9.27
Rate for Payer: United Healthcare Commercial $14.51
Rate for Payer: United Healthcare Medicare $9.27
Rate for Payer: WINHealth Partners Commercial $14.43
Rate for Payer: Wise Provider Network Commercial $14.43
Service Code NDC 8068113900
Hospital Revenue Code 250
Min. Negotiated Rate $8.17
Max. Negotiated Rate $15.09
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.79
Rate for Payer: Aetna of WY Medicare $9.96
Rate for Payer: Altius Commercial $14.49
Rate for Payer: Beech Street Commercial $14.79
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.64
Rate for Payer: Cash Price $10.56
Rate for Payer: ChoiceCare Network Commercial $14.64
Rate for Payer: Cigna of WY Commercial $14.79
Rate for Payer: Entrust Commercial $14.34
Rate for Payer: First Choice Health Commercial $14.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $8.60
Rate for Payer: HealthUtah PPO $15.09
Rate for Payer: Idaho Integrated Healthcare Commercial $14.64
Rate for Payer: Multiplan Medicare/VA $8.17
Rate for Payer: One Health Plan of WY PPO $14.79
Rate for Payer: PacificSource Commercial $13.58
Rate for Payer: PHCS PPO $14.79
Rate for Payer: Three Rivers PPO $11.32
Rate for Payer: TriWest Veterans Administration $8.60
Rate for Payer: United Healthcare Commercial $14.41
Rate for Payer: United Healthcare Medicare $8.60
Rate for Payer: WINHealth Partners Commercial $14.79
Rate for Payer: Wise Provider Network Commercial $14.34
Service Code NDC 8068113900
Hospital Revenue Code 250
Min. Negotiated Rate $8.74
Max. Negotiated Rate $15.09
Rate for Payer: Aetna of WY Commercial/Medical Rental $14.79
Rate for Payer: Aetna of WY Medicare $9.66
Rate for Payer: Altius Commercial $14.49
Rate for Payer: Beech Street Commercial $14.79
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $14.64
Rate for Payer: Cash Price $10.56
Rate for Payer: ChoiceCare Network Commercial $14.64
Rate for Payer: Cigna of WY Commercial $14.79
Rate for Payer: Entrust Commercial $14.34
Rate for Payer: First Choice Health Commercial $14.34
Rate for Payer: Government Employees Health Association (GEHA) Commercial $14.34
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.20
Rate for Payer: HealthUtah PPO $15.09
Rate for Payer: Idaho Integrated Healthcare Commercial $14.64
Rate for Payer: Multiplan Medicare/VA $8.74
Rate for Payer: One Health Plan of WY PPO $14.79
Rate for Payer: PacificSource Commercial $13.58
Rate for Payer: PHCS PPO $14.79
Rate for Payer: Three Rivers PPO $11.32
Rate for Payer: TriWest Veterans Administration $9.20
Rate for Payer: United Healthcare Commercial $14.41
Rate for Payer: United Healthcare Medicare $9.20
Rate for Payer: WINHealth Partners Commercial $14.34
Rate for Payer: Wise Provider Network Commercial $14.34
Service Code NDC 6425390030
Hospital Revenue Code 250
Min. Negotiated Rate $10.78
Max. Negotiated Rate $18.60
Rate for Payer: Aetna of WY Commercial/Medical Rental $18.23
Rate for Payer: Aetna of WY Medicare $11.90
Rate for Payer: Altius Commercial $17.86
Rate for Payer: Beech Street Commercial $18.23
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $18.04
Rate for Payer: Cash Price $13.02
Rate for Payer: ChoiceCare Network Commercial $18.04
Rate for Payer: Cigna of WY Commercial $18.23
Rate for Payer: Entrust Commercial $17.67
Rate for Payer: First Choice Health Commercial $17.67
Rate for Payer: Government Employees Health Association (GEHA) Commercial $17.67
Rate for Payer: Government Employees Health Association (GEHA) Medicare $11.35
Rate for Payer: HealthUtah PPO $18.60
Rate for Payer: Idaho Integrated Healthcare Commercial $18.04
Rate for Payer: Multiplan Medicare/VA $10.78
Rate for Payer: One Health Plan of WY PPO $18.23
Rate for Payer: PacificSource Commercial $16.74
Rate for Payer: PHCS PPO $18.23
Rate for Payer: Three Rivers PPO $13.95
Rate for Payer: TriWest Veterans Administration $11.35
Rate for Payer: United Healthcare Commercial $17.76
Rate for Payer: United Healthcare Medicare $11.35
Rate for Payer: WINHealth Partners Commercial $17.67
Rate for Payer: Wise Provider Network Commercial $17.67
Service Code NDC 6425390030
Hospital Revenue Code 250
Min. Negotiated Rate $10.07
Max. Negotiated Rate $18.60
Rate for Payer: Aetna of WY Commercial/Medical Rental $18.23
Rate for Payer: Aetna of WY Medicare $12.28
Rate for Payer: Altius Commercial $17.86
Rate for Payer: Beech Street Commercial $18.23
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $18.04
Rate for Payer: Cash Price $13.02
Rate for Payer: ChoiceCare Network Commercial $18.04
Rate for Payer: Cigna of WY Commercial $18.23
Rate for Payer: Entrust Commercial $17.67
Rate for Payer: First Choice Health Commercial $17.67
Rate for Payer: Government Employees Health Association (GEHA) Commercial $17.67
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.60
Rate for Payer: HealthUtah PPO $18.60
Rate for Payer: Idaho Integrated Healthcare Commercial $18.04
Rate for Payer: Multiplan Medicare/VA $10.07
Rate for Payer: One Health Plan of WY PPO $18.23
Rate for Payer: PacificSource Commercial $16.74
Rate for Payer: PHCS PPO $18.23
Rate for Payer: Three Rivers PPO $13.95
Rate for Payer: TriWest Veterans Administration $10.60
Rate for Payer: United Healthcare Commercial $17.76
Rate for Payer: United Healthcare Medicare $10.60
Rate for Payer: WINHealth Partners Commercial $18.23
Rate for Payer: Wise Provider Network Commercial $17.67
Service Code HCPCS J0612
Hospital Revenue Code 636
Min. Negotiated Rate $8.98
Max. Negotiated Rate $16.58
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.25
Rate for Payer: Aetna of WY Medicare $10.94
Rate for Payer: Altius Commercial $15.92
Rate for Payer: Beech Street Commercial $16.25
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.08
Rate for Payer: Cash Price $11.61
Rate for Payer: ChoiceCare Network Commercial $16.08
Rate for Payer: Cigna of WY Commercial $16.25
Rate for Payer: Entrust Commercial $15.75
Rate for Payer: First Choice Health Commercial $15.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $15.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $9.45
Rate for Payer: HealthUtah PPO $16.58
Rate for Payer: Idaho Integrated Healthcare Commercial $16.08
Rate for Payer: Multiplan Medicare/VA $8.98
Rate for Payer: One Health Plan of WY PPO $16.25
Rate for Payer: PacificSource Commercial $14.92
Rate for Payer: PHCS PPO $16.25
Rate for Payer: Three Rivers PPO $12.44
Rate for Payer: TriWest Veterans Administration $9.45
Rate for Payer: United Healthcare Commercial $15.83
Rate for Payer: United Healthcare Medicare $9.45
Rate for Payer: WINHealth Partners Commercial $16.25
Rate for Payer: Wise Provider Network Commercial $15.75
Service Code HCPCS J0612
Hospital Revenue Code 636
Min. Negotiated Rate $9.61
Max. Negotiated Rate $16.58
Rate for Payer: Aetna of WY Commercial/Medical Rental $16.25
Rate for Payer: Aetna of WY Medicare $10.61
Rate for Payer: Altius Commercial $15.92
Rate for Payer: Beech Street Commercial $16.25
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $16.08
Rate for Payer: Cash Price $11.61
Rate for Payer: ChoiceCare Network Commercial $16.08
Rate for Payer: Cigna of WY Commercial $16.25
Rate for Payer: Entrust Commercial $15.75
Rate for Payer: First Choice Health Commercial $15.75
Rate for Payer: Government Employees Health Association (GEHA) Commercial $15.75
Rate for Payer: Government Employees Health Association (GEHA) Medicare $10.11
Rate for Payer: HealthUtah PPO $16.58
Rate for Payer: Idaho Integrated Healthcare Commercial $16.08
Rate for Payer: Multiplan Medicare/VA $9.61
Rate for Payer: One Health Plan of WY PPO $16.25
Rate for Payer: PacificSource Commercial $14.92
Rate for Payer: PHCS PPO $16.25
Rate for Payer: Three Rivers PPO $12.44
Rate for Payer: TriWest Veterans Administration $10.11
Rate for Payer: United Healthcare Commercial $15.83
Rate for Payer: United Healthcare Medicare $10.11
Rate for Payer: WINHealth Partners Commercial $15.75
Rate for Payer: Wise Provider Network Commercial $15.75