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Service Code NDC 2315569405
Hospital Revenue Code 250
Min. Negotiated Rate $0.50
Max. Negotiated Rate $0.80
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.78
Rate for Payer: Altius Auto/Workers Compensation $0.77
Rate for Payer: Altius Commercial $0.77
Rate for Payer: Beech Street Commercial $0.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.66
Rate for Payer: Cash Price $0.56
Rate for Payer: ChoiceCare Network Commercial $0.78
Rate for Payer: Cigna of WY Commercial $0.78
Rate for Payer: Entrust Commercial $0.76
Rate for Payer: First Choice Health Commercial $0.76
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.76
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.53
Rate for Payer: HealthUtah PPO $0.80
Rate for Payer: Idaho Integrated Healthcare Commercial $0.78
Rate for Payer: Multiplan Medicare/VA $0.50
Rate for Payer: One Health Plan of WY PPO $0.78
Rate for Payer: PacificSource Commercial $0.72
Rate for Payer: PHCS PPO $0.78
Rate for Payer: Three Rivers PPO $0.60
Rate for Payer: TriWest Veterans Administration $0.53
Rate for Payer: United Healthcare Commercial $0.70
Rate for Payer: United Healthcare Medicare $0.53
Rate for Payer: WINHealth Partners Commercial $0.76
Rate for Payer: Wise Provider Network Commercial $0.76
Service Code NDC 0378018101
Hospital Revenue Code 250
Min. Negotiated Rate $1.43
Max. Negotiated Rate $2.28
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.23
Rate for Payer: Altius Auto/Workers Compensation $2.19
Rate for Payer: Altius Commercial $2.19
Rate for Payer: Beech Street Commercial $2.23
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.87
Rate for Payer: Cash Price $1.60
Rate for Payer: ChoiceCare Network Commercial $2.21
Rate for Payer: Cigna of WY Commercial $2.23
Rate for Payer: Entrust Commercial $2.17
Rate for Payer: First Choice Health Commercial $2.17
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.17
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.50
Rate for Payer: HealthUtah PPO $2.28
Rate for Payer: Idaho Integrated Healthcare Commercial $2.21
Rate for Payer: Multiplan Medicare/VA $1.43
Rate for Payer: One Health Plan of WY PPO $2.23
Rate for Payer: PacificSource Commercial $2.05
Rate for Payer: PHCS PPO $2.23
Rate for Payer: Three Rivers PPO $1.71
Rate for Payer: TriWest Veterans Administration $1.50
Rate for Payer: United Healthcare Commercial $1.98
Rate for Payer: United Healthcare Medicare $1.50
Rate for Payer: WINHealth Partners Commercial $2.17
Rate for Payer: Wise Provider Network Commercial $2.17
Service Code NDC 6068768811
Hospital Revenue Code 250
Min. Negotiated Rate $1.84
Max. Negotiated Rate $2.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.88
Rate for Payer: Altius Auto/Workers Compensation $2.82
Rate for Payer: Altius Commercial $2.82
Rate for Payer: Beech Street Commercial $2.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.41
Rate for Payer: Cash Price $2.06
Rate for Payer: ChoiceCare Network Commercial $2.85
Rate for Payer: Cigna of WY Commercial $2.88
Rate for Payer: Entrust Commercial $2.79
Rate for Payer: First Choice Health Commercial $2.79
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.79
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.94
Rate for Payer: HealthUtah PPO $2.94
Rate for Payer: Idaho Integrated Healthcare Commercial $2.85
Rate for Payer: Multiplan Medicare/VA $1.84
Rate for Payer: One Health Plan of WY PPO $2.88
Rate for Payer: PacificSource Commercial $2.65
Rate for Payer: PHCS PPO $2.88
Rate for Payer: Three Rivers PPO $2.20
Rate for Payer: TriWest Veterans Administration $1.94
Rate for Payer: United Healthcare Commercial $2.56
Rate for Payer: United Healthcare Medicare $1.94
Rate for Payer: WINHealth Partners Commercial $2.79
Rate for Payer: Wise Provider Network Commercial $2.79
Service Code NDC 6068768801
Hospital Revenue Code 250
Min. Negotiated Rate $1.84
Max. Negotiated Rate $2.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.88
Rate for Payer: Altius Auto/Workers Compensation $2.82
Rate for Payer: Altius Commercial $2.82
Rate for Payer: Beech Street Commercial $2.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.41
Rate for Payer: Cash Price $2.06
Rate for Payer: ChoiceCare Network Commercial $2.85
Rate for Payer: Cigna of WY Commercial $2.88
Rate for Payer: Entrust Commercial $2.79
Rate for Payer: First Choice Health Commercial $2.79
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.79
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.94
Rate for Payer: HealthUtah PPO $2.94
Rate for Payer: Idaho Integrated Healthcare Commercial $2.85
Rate for Payer: Multiplan Medicare/VA $1.84
Rate for Payer: One Health Plan of WY PPO $2.88
Rate for Payer: PacificSource Commercial $2.65
Rate for Payer: PHCS PPO $2.88
Rate for Payer: Three Rivers PPO $2.20
Rate for Payer: TriWest Veterans Administration $1.94
Rate for Payer: United Healthcare Commercial $2.56
Rate for Payer: United Healthcare Medicare $1.94
Rate for Payer: WINHealth Partners Commercial $2.79
Rate for Payer: Wise Provider Network Commercial $2.79
Service Code NDC 6068768801
Hospital Revenue Code 250
Min. Negotiated Rate $1.62
Max. Negotiated Rate $2.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.88
Rate for Payer: Aetna of WY Medicare $1.94
Rate for Payer: Altius Auto/Workers Compensation $2.82
Rate for Payer: Altius Commercial $2.82
Rate for Payer: Beech Street Commercial $2.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.41
Rate for Payer: Cash Price $2.06
Rate for Payer: ChoiceCare Network Commercial $2.85
Rate for Payer: Cigna of WY Commercial $2.88
Rate for Payer: Entrust Commercial $2.79
Rate for Payer: First Choice Health Commercial $2.79
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.79
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.71
Rate for Payer: HealthUtah PPO $2.94
Rate for Payer: Idaho Integrated Healthcare Commercial $2.85
Rate for Payer: Multiplan Medicare/VA $1.62
Rate for Payer: One Health Plan of WY PPO $2.88
Rate for Payer: PacificSource Commercial $2.65
Rate for Payer: PHCS PPO $2.88
Rate for Payer: Three Rivers PPO $2.20
Rate for Payer: TriWest Veterans Administration $1.71
Rate for Payer: United Healthcare Commercial $2.56
Rate for Payer: United Healthcare Medicare $1.71
Rate for Payer: WINHealth Partners Commercial $2.88
Rate for Payer: Wise Provider Network Commercial $2.79
Service Code NDC 6068768811
Hospital Revenue Code 250
Min. Negotiated Rate $1.62
Max. Negotiated Rate $2.94
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.88
Rate for Payer: Aetna of WY Medicare $1.94
Rate for Payer: Altius Auto/Workers Compensation $2.82
Rate for Payer: Altius Commercial $2.82
Rate for Payer: Beech Street Commercial $2.88
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2.41
Rate for Payer: Cash Price $2.06
Rate for Payer: ChoiceCare Network Commercial $2.85
Rate for Payer: Cigna of WY Commercial $2.88
Rate for Payer: Entrust Commercial $2.79
Rate for Payer: First Choice Health Commercial $2.79
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.79
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.71
Rate for Payer: HealthUtah PPO $2.94
Rate for Payer: Idaho Integrated Healthcare Commercial $2.85
Rate for Payer: Multiplan Medicare/VA $1.62
Rate for Payer: One Health Plan of WY PPO $2.88
Rate for Payer: PacificSource Commercial $2.65
Rate for Payer: PHCS PPO $2.88
Rate for Payer: Three Rivers PPO $2.20
Rate for Payer: TriWest Veterans Administration $1.71
Rate for Payer: United Healthcare Commercial $2.56
Rate for Payer: United Healthcare Medicare $1.71
Rate for Payer: WINHealth Partners Commercial $2.88
Rate for Payer: Wise Provider Network Commercial $2.79
Service Code NDC 0378018101
Hospital Revenue Code 250
Min. Negotiated Rate $1.26
Max. Negotiated Rate $2.28
Rate for Payer: Aetna of WY Commercial/Medical Rental $2.23
Rate for Payer: Aetna of WY Medicare $1.50
Rate for Payer: Altius Auto/Workers Compensation $2.19
Rate for Payer: Altius Commercial $2.19
Rate for Payer: Beech Street Commercial $2.23
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.87
Rate for Payer: Cash Price $1.60
Rate for Payer: ChoiceCare Network Commercial $2.21
Rate for Payer: Cigna of WY Commercial $2.23
Rate for Payer: Entrust Commercial $2.17
Rate for Payer: First Choice Health Commercial $2.17
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2.17
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1.32
Rate for Payer: HealthUtah PPO $2.28
Rate for Payer: Idaho Integrated Healthcare Commercial $2.21
Rate for Payer: Multiplan Medicare/VA $1.26
Rate for Payer: One Health Plan of WY PPO $2.23
Rate for Payer: PacificSource Commercial $2.05
Rate for Payer: PHCS PPO $2.23
Rate for Payer: Three Rivers PPO $1.71
Rate for Payer: TriWest Veterans Administration $1.32
Rate for Payer: United Healthcare Commercial $1.98
Rate for Payer: United Healthcare Medicare $1.32
Rate for Payer: WINHealth Partners Commercial $2.23
Rate for Payer: Wise Provider Network Commercial $2.17
Hospital Charge Code 27800000S1
Hospital Revenue Code 278
Min. Negotiated Rate $3,332.13
Max. Negotiated Rate $5,314.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,208.11
Rate for Payer: Altius Auto/Workers Compensation $5,101.82
Rate for Payer: Altius Commercial $5,101.82
Rate for Payer: Beech Street Commercial $5,208.11
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,363.12
Rate for Payer: Cash Price $3,720.08
Rate for Payer: ChoiceCare Network Commercial $5,154.97
Rate for Payer: Cigna of WY Commercial $5,208.11
Rate for Payer: Entrust Commercial $5,048.68
Rate for Payer: First Choice Health Commercial $5,048.68
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,048.68
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,507.50
Rate for Payer: HealthUtah PPO $5,314.40
Rate for Payer: Idaho Integrated Healthcare Commercial $5,154.97
Rate for Payer: Multiplan Medicare/VA $3,332.13
Rate for Payer: One Health Plan of WY PPO $5,208.11
Rate for Payer: PacificSource Commercial $4,782.96
Rate for Payer: PHCS PPO $5,208.11
Rate for Payer: Three Rivers PPO $3,985.80
Rate for Payer: TriWest Veterans Administration $3,507.50
Rate for Payer: United Healthcare Commercial $4,623.53
Rate for Payer: United Healthcare Medicare $3,507.50
Rate for Payer: WINHealth Partners Commercial $5,048.68
Rate for Payer: Wise Provider Network Commercial $5,048.68
Hospital Charge Code 27800000S1
Hospital Revenue Code 278
Min. Negotiated Rate $2,928.23
Max. Negotiated Rate $5,314.40
Rate for Payer: Aetna of WY Commercial/Medical Rental $5,208.11
Rate for Payer: Aetna of WY Medicare $3,507.50
Rate for Payer: Altius Auto/Workers Compensation $5,101.82
Rate for Payer: Altius Commercial $5,101.82
Rate for Payer: Beech Street Commercial $5,208.11
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $4,363.12
Rate for Payer: Cash Price $3,720.08
Rate for Payer: ChoiceCare Network Commercial $5,154.97
Rate for Payer: Cigna of WY Commercial $5,208.11
Rate for Payer: Entrust Commercial $5,048.68
Rate for Payer: First Choice Health Commercial $5,048.68
Rate for Payer: Government Employees Health Association (GEHA) Commercial $5,048.68
Rate for Payer: Government Employees Health Association (GEHA) Medicare $3,082.35
Rate for Payer: HealthUtah PPO $5,314.40
Rate for Payer: Idaho Integrated Healthcare Commercial $5,154.97
Rate for Payer: Multiplan Medicare/VA $2,928.23
Rate for Payer: One Health Plan of WY PPO $5,208.11
Rate for Payer: PacificSource Commercial $4,782.96
Rate for Payer: PHCS PPO $5,208.11
Rate for Payer: Three Rivers PPO $3,985.80
Rate for Payer: TriWest Veterans Administration $3,082.35
Rate for Payer: United Healthcare Commercial $4,623.53
Rate for Payer: United Healthcare Medicare $3,082.35
Rate for Payer: WINHealth Partners Commercial $5,208.11
Rate for Payer: Wise Provider Network Commercial $5,048.68
Hospital Charge Code 27800000S1
Hospital Revenue Code 278
Min. Negotiated Rate $1,689.37
Max. Negotiated Rate $3,066.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,004.68
Rate for Payer: Aetna of WY Medicare $2,023.56
Rate for Payer: Altius Auto/Workers Compensation $2,943.36
Rate for Payer: Altius Commercial $2,943.36
Rate for Payer: Beech Street Commercial $3,004.68
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,517.19
Rate for Payer: Cash Price $2,146.20
Rate for Payer: ChoiceCare Network Commercial $2,974.02
Rate for Payer: Cigna of WY Commercial $3,004.68
Rate for Payer: Entrust Commercial $2,912.70
Rate for Payer: First Choice Health Commercial $2,912.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,912.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $1,778.28
Rate for Payer: HealthUtah PPO $3,066.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,974.02
Rate for Payer: Multiplan Medicare/VA $1,689.37
Rate for Payer: One Health Plan of WY PPO $3,004.68
Rate for Payer: PacificSource Commercial $2,759.40
Rate for Payer: PHCS PPO $3,004.68
Rate for Payer: Three Rivers PPO $2,299.50
Rate for Payer: TriWest Veterans Administration $1,778.28
Rate for Payer: United Healthcare Commercial $2,667.42
Rate for Payer: United Healthcare Medicare $1,778.28
Rate for Payer: WINHealth Partners Commercial $3,004.68
Rate for Payer: Wise Provider Network Commercial $2,912.70
Hospital Charge Code 27800000S1
Hospital Revenue Code 278
Min. Negotiated Rate $1,922.38
Max. Negotiated Rate $3,066.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $3,004.68
Rate for Payer: Altius Auto/Workers Compensation $2,943.36
Rate for Payer: Altius Commercial $2,943.36
Rate for Payer: Beech Street Commercial $3,004.68
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $2,517.19
Rate for Payer: Cash Price $2,146.20
Rate for Payer: ChoiceCare Network Commercial $2,974.02
Rate for Payer: Cigna of WY Commercial $3,004.68
Rate for Payer: Entrust Commercial $2,912.70
Rate for Payer: First Choice Health Commercial $2,912.70
Rate for Payer: Government Employees Health Association (GEHA) Commercial $2,912.70
Rate for Payer: Government Employees Health Association (GEHA) Medicare $2,023.56
Rate for Payer: HealthUtah PPO $3,066.00
Rate for Payer: Idaho Integrated Healthcare Commercial $2,974.02
Rate for Payer: Multiplan Medicare/VA $1,922.38
Rate for Payer: One Health Plan of WY PPO $3,004.68
Rate for Payer: PacificSource Commercial $2,759.40
Rate for Payer: PHCS PPO $3,004.68
Rate for Payer: Three Rivers PPO $2,299.50
Rate for Payer: TriWest Veterans Administration $2,023.56
Rate for Payer: United Healthcare Commercial $2,667.42
Rate for Payer: United Healthcare Medicare $2,023.56
Rate for Payer: WINHealth Partners Commercial $2,912.70
Rate for Payer: Wise Provider Network Commercial $2,912.70
Service Code HCPCS J0256
Hospital Revenue Code 636
Min. Negotiated Rate $376.20
Max. Negotiated Rate $600.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $588.00
Rate for Payer: Altius Auto/Workers Compensation $576.00
Rate for Payer: Altius Commercial $576.00
Rate for Payer: Beech Street Commercial $588.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $492.60
Rate for Payer: Cash Price $420.00
Rate for Payer: ChoiceCare Network Commercial $582.00
Rate for Payer: Cigna of WY Commercial $588.00
Rate for Payer: Entrust Commercial $570.00
Rate for Payer: First Choice Health Commercial $570.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $570.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $396.00
Rate for Payer: HealthUtah PPO $600.00
Rate for Payer: Idaho Integrated Healthcare Commercial $582.00
Rate for Payer: Multiplan Medicare/VA $376.20
Rate for Payer: One Health Plan of WY PPO $588.00
Rate for Payer: PacificSource Commercial $540.00
Rate for Payer: PHCS PPO $588.00
Rate for Payer: Three Rivers PPO $450.00
Rate for Payer: TriWest Veterans Administration $396.00
Rate for Payer: United Healthcare Commercial $522.00
Rate for Payer: United Healthcare Medicare $396.00
Rate for Payer: WINHealth Partners Commercial $570.00
Rate for Payer: Wise Provider Network Commercial $570.00
Service Code HCPCS J0256
Hospital Revenue Code 636
Min. Negotiated Rate $330.60
Max. Negotiated Rate $600.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $588.00
Rate for Payer: Aetna of WY Medicare $396.00
Rate for Payer: Altius Auto/Workers Compensation $576.00
Rate for Payer: Altius Commercial $576.00
Rate for Payer: Beech Street Commercial $588.00
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $492.60
Rate for Payer: Cash Price $420.00
Rate for Payer: ChoiceCare Network Commercial $582.00
Rate for Payer: Cigna of WY Commercial $588.00
Rate for Payer: Entrust Commercial $570.00
Rate for Payer: First Choice Health Commercial $570.00
Rate for Payer: Government Employees Health Association (GEHA) Commercial $570.00
Rate for Payer: Government Employees Health Association (GEHA) Medicare $348.00
Rate for Payer: HealthUtah PPO $600.00
Rate for Payer: Idaho Integrated Healthcare Commercial $582.00
Rate for Payer: Multiplan Medicare/VA $330.60
Rate for Payer: One Health Plan of WY PPO $588.00
Rate for Payer: PacificSource Commercial $540.00
Rate for Payer: PHCS PPO $588.00
Rate for Payer: Three Rivers PPO $450.00
Rate for Payer: TriWest Veterans Administration $348.00
Rate for Payer: United Healthcare Commercial $522.00
Rate for Payer: United Healthcare Medicare $348.00
Rate for Payer: WINHealth Partners Commercial $588.00
Rate for Payer: Wise Provider Network Commercial $570.00
Service Code NDC 0228202910
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.20
Rate for Payer: Altius Auto/Workers Compensation $0.19
Rate for Payer: Altius Commercial $0.19
Rate for Payer: Beech Street Commercial $0.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.16
Rate for Payer: Cash Price $0.14
Rate for Payer: ChoiceCare Network Commercial $0.19
Rate for Payer: Cigna of WY Commercial $0.20
Rate for Payer: Entrust Commercial $0.19
Rate for Payer: First Choice Health Commercial $0.19
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.19
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.13
Rate for Payer: HealthUtah PPO $0.20
Rate for Payer: Idaho Integrated Healthcare Commercial $0.19
Rate for Payer: Multiplan Medicare/VA $0.13
Rate for Payer: One Health Plan of WY PPO $0.20
Rate for Payer: PacificSource Commercial $0.18
Rate for Payer: PHCS PPO $0.20
Rate for Payer: Three Rivers PPO $0.15
Rate for Payer: TriWest Veterans Administration $0.13
Rate for Payer: United Healthcare Commercial $0.17
Rate for Payer: United Healthcare Medicare $0.13
Rate for Payer: WINHealth Partners Commercial $0.19
Rate for Payer: Wise Provider Network Commercial $0.19
Service Code NDC 0228202910
Hospital Revenue Code 250
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.20
Rate for Payer: Aetna of WY Commercial/Medical Rental $0.20
Rate for Payer: Aetna of WY Medicare $0.13
Rate for Payer: Altius Auto/Workers Compensation $0.19
Rate for Payer: Altius Commercial $0.19
Rate for Payer: Beech Street Commercial $0.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $0.16
Rate for Payer: Cash Price $0.14
Rate for Payer: ChoiceCare Network Commercial $0.19
Rate for Payer: Cigna of WY Commercial $0.20
Rate for Payer: Entrust Commercial $0.19
Rate for Payer: First Choice Health Commercial $0.19
Rate for Payer: Government Employees Health Association (GEHA) Commercial $0.19
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.12
Rate for Payer: HealthUtah PPO $0.20
Rate for Payer: Idaho Integrated Healthcare Commercial $0.19
Rate for Payer: Multiplan Medicare/VA $0.11
Rate for Payer: One Health Plan of WY PPO $0.20
Rate for Payer: PacificSource Commercial $0.18
Rate for Payer: PHCS PPO $0.20
Rate for Payer: Three Rivers PPO $0.15
Rate for Payer: TriWest Veterans Administration $0.12
Rate for Payer: United Healthcare Commercial $0.17
Rate for Payer: United Healthcare Medicare $0.12
Rate for Payer: WINHealth Partners Commercial $0.20
Rate for Payer: Wise Provider Network Commercial $0.19
Service Code NDC 6068738811
Hospital Revenue Code 250
Min. Negotiated Rate $0.92
Max. Negotiated Rate $1.47
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.44
Rate for Payer: Altius Auto/Workers Compensation $1.41
Rate for Payer: Altius Commercial $1.41
Rate for Payer: Beech Street Commercial $1.44
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.21
Rate for Payer: Cash Price $1.03
Rate for Payer: ChoiceCare Network Commercial $1.43
Rate for Payer: Cigna of WY Commercial $1.44
Rate for Payer: Entrust Commercial $1.40
Rate for Payer: First Choice Health Commercial $1.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.97
Rate for Payer: HealthUtah PPO $1.47
Rate for Payer: Idaho Integrated Healthcare Commercial $1.43
Rate for Payer: Multiplan Medicare/VA $0.92
Rate for Payer: One Health Plan of WY PPO $1.44
Rate for Payer: PacificSource Commercial $1.32
Rate for Payer: PHCS PPO $1.44
Rate for Payer: Three Rivers PPO $1.10
Rate for Payer: TriWest Veterans Administration $0.97
Rate for Payer: United Healthcare Commercial $1.28
Rate for Payer: United Healthcare Medicare $0.97
Rate for Payer: WINHealth Partners Commercial $1.40
Rate for Payer: Wise Provider Network Commercial $1.40
Service Code NDC 6068738811
Hospital Revenue Code 250
Min. Negotiated Rate $0.81
Max. Negotiated Rate $1.47
Rate for Payer: Aetna of WY Commercial/Medical Rental $1.44
Rate for Payer: Aetna of WY Medicare $0.97
Rate for Payer: Altius Auto/Workers Compensation $1.41
Rate for Payer: Altius Commercial $1.41
Rate for Payer: Beech Street Commercial $1.44
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $1.21
Rate for Payer: Cash Price $1.03
Rate for Payer: ChoiceCare Network Commercial $1.43
Rate for Payer: Cigna of WY Commercial $1.44
Rate for Payer: Entrust Commercial $1.40
Rate for Payer: First Choice Health Commercial $1.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $1.40
Rate for Payer: Government Employees Health Association (GEHA) Medicare $0.85
Rate for Payer: HealthUtah PPO $1.47
Rate for Payer: Idaho Integrated Healthcare Commercial $1.43
Rate for Payer: Multiplan Medicare/VA $0.81
Rate for Payer: One Health Plan of WY PPO $1.44
Rate for Payer: PacificSource Commercial $1.32
Rate for Payer: PHCS PPO $1.44
Rate for Payer: Three Rivers PPO $1.10
Rate for Payer: TriWest Veterans Administration $0.85
Rate for Payer: United Healthcare Commercial $1.28
Rate for Payer: United Healthcare Medicare $0.85
Rate for Payer: WINHealth Partners Commercial $1.44
Rate for Payer: Wise Provider Network Commercial $1.40
Service Code NDC 0009316901
Hospital Revenue Code 250
Min. Negotiated Rate $141.56
Max. Negotiated Rate $256.92
Rate for Payer: Aetna of WY Commercial/Medical Rental $251.78
Rate for Payer: Aetna of WY Medicare $169.57
Rate for Payer: Altius Auto/Workers Compensation $246.64
Rate for Payer: Altius Commercial $246.64
Rate for Payer: Beech Street Commercial $251.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $210.93
Rate for Payer: Cash Price $179.84
Rate for Payer: ChoiceCare Network Commercial $249.21
Rate for Payer: Cigna of WY Commercial $251.78
Rate for Payer: Entrust Commercial $244.07
Rate for Payer: First Choice Health Commercial $244.07
Rate for Payer: Government Employees Health Association (GEHA) Commercial $244.07
Rate for Payer: Government Employees Health Association (GEHA) Medicare $149.01
Rate for Payer: HealthUtah PPO $256.92
Rate for Payer: Idaho Integrated Healthcare Commercial $249.21
Rate for Payer: Multiplan Medicare/VA $141.56
Rate for Payer: One Health Plan of WY PPO $251.78
Rate for Payer: PacificSource Commercial $231.23
Rate for Payer: PHCS PPO $251.78
Rate for Payer: Three Rivers PPO $192.69
Rate for Payer: TriWest Veterans Administration $149.01
Rate for Payer: United Healthcare Commercial $223.52
Rate for Payer: United Healthcare Medicare $149.01
Rate for Payer: WINHealth Partners Commercial $251.78
Rate for Payer: Wise Provider Network Commercial $244.07
Service Code NDC 0009316906
Hospital Revenue Code 250
Min. Negotiated Rate $141.56
Max. Negotiated Rate $256.92
Rate for Payer: Aetna of WY Commercial/Medical Rental $251.78
Rate for Payer: Aetna of WY Medicare $169.57
Rate for Payer: Altius Auto/Workers Compensation $246.64
Rate for Payer: Altius Commercial $246.64
Rate for Payer: Beech Street Commercial $251.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $210.93
Rate for Payer: Cash Price $179.84
Rate for Payer: ChoiceCare Network Commercial $249.21
Rate for Payer: Cigna of WY Commercial $251.78
Rate for Payer: Entrust Commercial $244.07
Rate for Payer: First Choice Health Commercial $244.07
Rate for Payer: Government Employees Health Association (GEHA) Commercial $244.07
Rate for Payer: Government Employees Health Association (GEHA) Medicare $149.01
Rate for Payer: HealthUtah PPO $256.92
Rate for Payer: Idaho Integrated Healthcare Commercial $249.21
Rate for Payer: Multiplan Medicare/VA $141.56
Rate for Payer: One Health Plan of WY PPO $251.78
Rate for Payer: PacificSource Commercial $231.23
Rate for Payer: PHCS PPO $251.78
Rate for Payer: Three Rivers PPO $192.69
Rate for Payer: TriWest Veterans Administration $149.01
Rate for Payer: United Healthcare Commercial $223.52
Rate for Payer: United Healthcare Medicare $149.01
Rate for Payer: WINHealth Partners Commercial $251.78
Rate for Payer: Wise Provider Network Commercial $244.07
Service Code NDC 0009316901
Hospital Revenue Code 250
Min. Negotiated Rate $161.09
Max. Negotiated Rate $256.92
Rate for Payer: Aetna of WY Commercial/Medical Rental $251.78
Rate for Payer: Altius Auto/Workers Compensation $246.64
Rate for Payer: Altius Commercial $246.64
Rate for Payer: Beech Street Commercial $251.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $210.93
Rate for Payer: Cash Price $179.84
Rate for Payer: ChoiceCare Network Commercial $249.21
Rate for Payer: Cigna of WY Commercial $251.78
Rate for Payer: Entrust Commercial $244.07
Rate for Payer: First Choice Health Commercial $244.07
Rate for Payer: Government Employees Health Association (GEHA) Commercial $244.07
Rate for Payer: Government Employees Health Association (GEHA) Medicare $169.57
Rate for Payer: HealthUtah PPO $256.92
Rate for Payer: Idaho Integrated Healthcare Commercial $249.21
Rate for Payer: Multiplan Medicare/VA $161.09
Rate for Payer: One Health Plan of WY PPO $251.78
Rate for Payer: PacificSource Commercial $231.23
Rate for Payer: PHCS PPO $251.78
Rate for Payer: Three Rivers PPO $192.69
Rate for Payer: TriWest Veterans Administration $169.57
Rate for Payer: United Healthcare Commercial $223.52
Rate for Payer: United Healthcare Medicare $169.57
Rate for Payer: WINHealth Partners Commercial $244.07
Rate for Payer: Wise Provider Network Commercial $244.07
Service Code NDC 0009316906
Hospital Revenue Code 250
Min. Negotiated Rate $161.09
Max. Negotiated Rate $256.92
Rate for Payer: Aetna of WY Commercial/Medical Rental $251.78
Rate for Payer: Altius Auto/Workers Compensation $246.64
Rate for Payer: Altius Commercial $246.64
Rate for Payer: Beech Street Commercial $251.78
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $210.93
Rate for Payer: Cash Price $179.84
Rate for Payer: ChoiceCare Network Commercial $249.21
Rate for Payer: Cigna of WY Commercial $251.78
Rate for Payer: Entrust Commercial $244.07
Rate for Payer: First Choice Health Commercial $244.07
Rate for Payer: Government Employees Health Association (GEHA) Commercial $244.07
Rate for Payer: Government Employees Health Association (GEHA) Medicare $169.57
Rate for Payer: HealthUtah PPO $256.92
Rate for Payer: Idaho Integrated Healthcare Commercial $249.21
Rate for Payer: Multiplan Medicare/VA $161.09
Rate for Payer: One Health Plan of WY PPO $251.78
Rate for Payer: PacificSource Commercial $231.23
Rate for Payer: PHCS PPO $251.78
Rate for Payer: Three Rivers PPO $192.69
Rate for Payer: TriWest Veterans Administration $169.57
Rate for Payer: United Healthcare Commercial $223.52
Rate for Payer: United Healthcare Medicare $169.57
Rate for Payer: WINHealth Partners Commercial $244.07
Rate for Payer: Wise Provider Network Commercial $244.07
Service Code HCPCS J2997
Hospital Revenue Code 636
Min. Negotiated Rate $174.16
Max. Negotiated Rate $277.76
Rate for Payer: Aetna of WY Commercial/Medical Rental $272.20
Rate for Payer: Altius Auto/Workers Compensation $266.65
Rate for Payer: Altius Commercial $266.65
Rate for Payer: Beech Street Commercial $272.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $228.04
Rate for Payer: Cash Price $194.43
Rate for Payer: ChoiceCare Network Commercial $269.43
Rate for Payer: Cigna of WY Commercial $272.20
Rate for Payer: Entrust Commercial $263.87
Rate for Payer: First Choice Health Commercial $263.87
Rate for Payer: Government Employees Health Association (GEHA) Commercial $263.87
Rate for Payer: Government Employees Health Association (GEHA) Medicare $183.32
Rate for Payer: HealthUtah PPO $277.76
Rate for Payer: Idaho Integrated Healthcare Commercial $269.43
Rate for Payer: Multiplan Medicare/VA $174.16
Rate for Payer: One Health Plan of WY PPO $272.20
Rate for Payer: PacificSource Commercial $249.98
Rate for Payer: PHCS PPO $272.20
Rate for Payer: Three Rivers PPO $208.32
Rate for Payer: TriWest Veterans Administration $183.32
Rate for Payer: United Healthcare Commercial $241.65
Rate for Payer: United Healthcare Medicare $183.32
Rate for Payer: WINHealth Partners Commercial $263.87
Rate for Payer: Wise Provider Network Commercial $263.87
Service Code HCPCS J2997
Hospital Revenue Code 636
Min. Negotiated Rate $153.05
Max. Negotiated Rate $277.76
Rate for Payer: Aetna of WY Commercial/Medical Rental $272.20
Rate for Payer: Aetna of WY Medicare $183.32
Rate for Payer: Altius Auto/Workers Compensation $266.65
Rate for Payer: Altius Commercial $266.65
Rate for Payer: Beech Street Commercial $272.20
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $228.04
Rate for Payer: Cash Price $194.43
Rate for Payer: ChoiceCare Network Commercial $269.43
Rate for Payer: Cigna of WY Commercial $272.20
Rate for Payer: Entrust Commercial $263.87
Rate for Payer: First Choice Health Commercial $263.87
Rate for Payer: Government Employees Health Association (GEHA) Commercial $263.87
Rate for Payer: Government Employees Health Association (GEHA) Medicare $161.10
Rate for Payer: HealthUtah PPO $277.76
Rate for Payer: Idaho Integrated Healthcare Commercial $269.43
Rate for Payer: Multiplan Medicare/VA $153.05
Rate for Payer: One Health Plan of WY PPO $272.20
Rate for Payer: PacificSource Commercial $249.98
Rate for Payer: PHCS PPO $272.20
Rate for Payer: Three Rivers PPO $208.32
Rate for Payer: TriWest Veterans Administration $161.10
Rate for Payer: United Healthcare Commercial $241.65
Rate for Payer: United Healthcare Medicare $161.10
Rate for Payer: WINHealth Partners Commercial $272.20
Rate for Payer: Wise Provider Network Commercial $263.87
Service Code HCPCS J2997
Hospital Charge Code J2997
Min. Negotiated Rate $75.50
Max. Negotiated Rate $376.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $368.48
Rate for Payer: Aetna of WY Medicare $88.82
Rate for Payer: Beech Street Commercial $357.20
Rate for Payer: Cash Price $263.20
Rate for Payer: Cash Price $263.20
Rate for Payer: ChoiceCare Network Commercial $364.72
Rate for Payer: Cigna of WY Commercial $368.48
Rate for Payer: First Choice Health Commercial $338.40
Rate for Payer: Government Employees Health Association (GEHA) Commercial $357.20
Rate for Payer: Government Employees Health Association (GEHA) Medicare $88.82
Rate for Payer: HealthUtah PPO $376.00
Rate for Payer: Idaho Integrated Healthcare Commercial $364.72
Rate for Payer: Multiplan Medicare/VA $75.50
Rate for Payer: One Health Plan of WY PPO $368.48
Rate for Payer: PacificSource Commercial $338.40
Rate for Payer: PHCS PPO $357.20
Rate for Payer: Three Rivers PPO $282.00
Rate for Payer: TriWest Veterans Administration $88.82
Rate for Payer: United Healthcare Commercial $327.12
Rate for Payer: United Healthcare Medicare $88.82
Rate for Payer: WINHealth Partners Commercial $357.20
Hospital Charge Code 27200000S1
Hospital Revenue Code 272
Min. Negotiated Rate $96.56
Max. Negotiated Rate $154.00
Rate for Payer: Aetna of WY Commercial/Medical Rental $150.92
Rate for Payer: Altius Auto/Workers Compensation $147.84
Rate for Payer: Altius Commercial $147.84
Rate for Payer: Beech Street Commercial $150.92
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial $126.43
Rate for Payer: Cash Price $107.80
Rate for Payer: ChoiceCare Network Commercial $149.38
Rate for Payer: Cigna of WY Commercial $150.92
Rate for Payer: Entrust Commercial $146.30
Rate for Payer: First Choice Health Commercial $146.30
Rate for Payer: Government Employees Health Association (GEHA) Commercial $146.30
Rate for Payer: Government Employees Health Association (GEHA) Medicare $101.64
Rate for Payer: HealthUtah PPO $154.00
Rate for Payer: Idaho Integrated Healthcare Commercial $149.38
Rate for Payer: Multiplan Medicare/VA $96.56
Rate for Payer: One Health Plan of WY PPO $150.92
Rate for Payer: PacificSource Commercial $138.60
Rate for Payer: PHCS PPO $150.92
Rate for Payer: Three Rivers PPO $115.50
Rate for Payer: TriWest Veterans Administration $101.64
Rate for Payer: United Healthcare Commercial $133.98
Rate for Payer: United Healthcare Medicare $101.64
Rate for Payer: WINHealth Partners Commercial $146.30
Rate for Payer: Wise Provider Network Commercial $146.30