|
SUT CORZA CHROMIC 5-0 P-3
|
Facility
|
IP
|
$14.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.80
|
| Rate for Payer: Altius Commercial |
$13.80
|
| Rate for Payer: Beech Street Commercial |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.81
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.95
|
| Rate for Payer: Cigna of WY Commercial |
$14.09
|
| Rate for Payer: Entrust Commercial |
$13.66
|
| Rate for Payer: First Choice Health Commercial |
$13.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.49
|
| Rate for Payer: HealthUtah PPO |
$14.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.95
|
| Rate for Payer: Multiplan Medicare/VA |
$9.02
|
| Rate for Payer: One Health Plan of WY PPO |
$14.09
|
| Rate for Payer: PacificSource Commercial |
$12.94
|
| Rate for Payer: PHCS PPO |
$14.09
|
| Rate for Payer: Three Rivers PPO |
$10.78
|
| Rate for Payer: TriWest Veterans Administration |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$12.51
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
| Rate for Payer: WINHealth Partners Commercial |
$13.66
|
| Rate for Payer: Wise Provider Network Commercial |
$13.66
|
|
|
SUT CORZA CHROMIC 5-0 P-3
|
Facility
|
OP
|
$14.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.09
|
| Rate for Payer: Aetna of WY Medicare |
$9.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.80
|
| Rate for Payer: Altius Commercial |
$13.80
|
| Rate for Payer: Beech Street Commercial |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.81
|
| Rate for Payer: Cash Price |
$10.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.95
|
| Rate for Payer: Cigna of WY Commercial |
$14.09
|
| Rate for Payer: Entrust Commercial |
$13.66
|
| Rate for Payer: First Choice Health Commercial |
$13.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.34
|
| Rate for Payer: HealthUtah PPO |
$14.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.95
|
| Rate for Payer: Multiplan Medicare/VA |
$7.92
|
| Rate for Payer: One Health Plan of WY PPO |
$14.09
|
| Rate for Payer: PacificSource Commercial |
$12.94
|
| Rate for Payer: PHCS PPO |
$14.09
|
| Rate for Payer: Three Rivers PPO |
$10.78
|
| Rate for Payer: TriWest Veterans Administration |
$8.34
|
| Rate for Payer: United Healthcare Commercial |
$12.51
|
| Rate for Payer: United Healthcare Medicare |
$8.34
|
| Rate for Payer: WINHealth Partners Commercial |
$14.09
|
| Rate for Payer: Wise Provider Network Commercial |
$13.66
|
|
|
SUT CORZA EXPRESS GUT 6-0 P-3 18"
|
Facility
|
OP
|
$29.24
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.66
|
| Rate for Payer: Aetna of WY Medicare |
$19.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.07
|
| Rate for Payer: Altius Commercial |
$28.07
|
| Rate for Payer: Beech Street Commercial |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.01
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.36
|
| Rate for Payer: Cigna of WY Commercial |
$28.66
|
| Rate for Payer: Entrust Commercial |
$27.78
|
| Rate for Payer: First Choice Health Commercial |
$27.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.96
|
| Rate for Payer: HealthUtah PPO |
$29.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.36
|
| Rate for Payer: Multiplan Medicare/VA |
$16.11
|
| Rate for Payer: One Health Plan of WY PPO |
$28.66
|
| Rate for Payer: PacificSource Commercial |
$26.32
|
| Rate for Payer: PHCS PPO |
$28.66
|
| Rate for Payer: Three Rivers PPO |
$21.93
|
| Rate for Payer: TriWest Veterans Administration |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$25.44
|
| Rate for Payer: United Healthcare Medicare |
$16.96
|
| Rate for Payer: WINHealth Partners Commercial |
$28.66
|
| Rate for Payer: Wise Provider Network Commercial |
$27.78
|
|
|
SUT CORZA EXPRESS GUT 6-0 P-3 18"
|
Facility
|
IP
|
$29.24
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.07
|
| Rate for Payer: Altius Commercial |
$28.07
|
| Rate for Payer: Beech Street Commercial |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.01
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.36
|
| Rate for Payer: Cigna of WY Commercial |
$28.66
|
| Rate for Payer: Entrust Commercial |
$27.78
|
| Rate for Payer: First Choice Health Commercial |
$27.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.30
|
| Rate for Payer: HealthUtah PPO |
$29.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.36
|
| Rate for Payer: Multiplan Medicare/VA |
$18.33
|
| Rate for Payer: One Health Plan of WY PPO |
$28.66
|
| Rate for Payer: PacificSource Commercial |
$26.32
|
| Rate for Payer: PHCS PPO |
$28.66
|
| Rate for Payer: Three Rivers PPO |
$21.93
|
| Rate for Payer: TriWest Veterans Administration |
$19.30
|
| Rate for Payer: United Healthcare Commercial |
$25.44
|
| Rate for Payer: United Healthcare Medicare |
$19.30
|
| Rate for Payer: WINHealth Partners Commercial |
$27.78
|
| Rate for Payer: Wise Provider Network Commercial |
$27.78
|
|
|
SUT ET CHROMIC 0 CT-1 812H
|
Facility
|
OP
|
$7.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$7.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.68
|
| Rate for Payer: Aetna of WY Medicare |
$5.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.53
|
| Rate for Payer: Altius Commercial |
$7.53
|
| Rate for Payer: Beech Street Commercial |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.44
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.60
|
| Rate for Payer: Cigna of WY Commercial |
$7.68
|
| Rate for Payer: Entrust Commercial |
$7.45
|
| Rate for Payer: First Choice Health Commercial |
$7.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.55
|
| Rate for Payer: HealthUtah PPO |
$7.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.60
|
| Rate for Payer: Multiplan Medicare/VA |
$4.32
|
| Rate for Payer: One Health Plan of WY PPO |
$7.68
|
| Rate for Payer: PacificSource Commercial |
$7.06
|
| Rate for Payer: PHCS PPO |
$7.68
|
| Rate for Payer: Three Rivers PPO |
$5.88
|
| Rate for Payer: TriWest Veterans Administration |
$4.55
|
| Rate for Payer: United Healthcare Commercial |
$6.82
|
| Rate for Payer: United Healthcare Medicare |
$4.55
|
| Rate for Payer: WINHealth Partners Commercial |
$7.68
|
| Rate for Payer: Wise Provider Network Commercial |
$7.45
|
|
|
SUT ET CHROMIC 0 CT-1 812H
|
Facility
|
IP
|
$7.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$7.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.53
|
| Rate for Payer: Altius Commercial |
$7.53
|
| Rate for Payer: Beech Street Commercial |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.44
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.60
|
| Rate for Payer: Cigna of WY Commercial |
$7.68
|
| Rate for Payer: Entrust Commercial |
$7.45
|
| Rate for Payer: First Choice Health Commercial |
$7.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.17
|
| Rate for Payer: HealthUtah PPO |
$7.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.60
|
| Rate for Payer: Multiplan Medicare/VA |
$4.92
|
| Rate for Payer: One Health Plan of WY PPO |
$7.68
|
| Rate for Payer: PacificSource Commercial |
$7.06
|
| Rate for Payer: PHCS PPO |
$7.68
|
| Rate for Payer: Three Rivers PPO |
$5.88
|
| Rate for Payer: TriWest Veterans Administration |
$5.17
|
| Rate for Payer: United Healthcare Commercial |
$6.82
|
| Rate for Payer: United Healthcare Medicare |
$5.17
|
| Rate for Payer: WINHealth Partners Commercial |
$7.45
|
| Rate for Payer: Wise Provider Network Commercial |
$7.45
|
|
|
SUT ET CHROMIC 1 CTX 905H
|
Facility
|
IP
|
$8.91
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.55
|
| Rate for Payer: Altius Commercial |
$8.55
|
| Rate for Payer: Beech Street Commercial |
$8.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.32
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.64
|
| Rate for Payer: Cigna of WY Commercial |
$8.73
|
| Rate for Payer: Entrust Commercial |
$8.46
|
| Rate for Payer: First Choice Health Commercial |
$8.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.88
|
| Rate for Payer: HealthUtah PPO |
$8.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.64
|
| Rate for Payer: Multiplan Medicare/VA |
$5.59
|
| Rate for Payer: One Health Plan of WY PPO |
$8.73
|
| Rate for Payer: PacificSource Commercial |
$8.02
|
| Rate for Payer: PHCS PPO |
$8.73
|
| Rate for Payer: Three Rivers PPO |
$6.68
|
| Rate for Payer: TriWest Veterans Administration |
$5.88
|
| Rate for Payer: United Healthcare Commercial |
$7.75
|
| Rate for Payer: United Healthcare Medicare |
$5.88
|
| Rate for Payer: WINHealth Partners Commercial |
$8.46
|
| Rate for Payer: Wise Provider Network Commercial |
$8.46
|
|
|
SUT ET CHROMIC 1 CTX 905H
|
Facility
|
OP
|
$8.91
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.73
|
| Rate for Payer: Aetna of WY Medicare |
$5.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.55
|
| Rate for Payer: Altius Commercial |
$8.55
|
| Rate for Payer: Beech Street Commercial |
$8.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.32
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.64
|
| Rate for Payer: Cigna of WY Commercial |
$8.73
|
| Rate for Payer: Entrust Commercial |
$8.46
|
| Rate for Payer: First Choice Health Commercial |
$8.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.17
|
| Rate for Payer: HealthUtah PPO |
$8.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.64
|
| Rate for Payer: Multiplan Medicare/VA |
$4.91
|
| Rate for Payer: One Health Plan of WY PPO |
$8.73
|
| Rate for Payer: PacificSource Commercial |
$8.02
|
| Rate for Payer: PHCS PPO |
$8.73
|
| Rate for Payer: Three Rivers PPO |
$6.68
|
| Rate for Payer: TriWest Veterans Administration |
$5.17
|
| Rate for Payer: United Healthcare Commercial |
$7.75
|
| Rate for Payer: United Healthcare Medicare |
$5.17
|
| Rate for Payer: WINHealth Partners Commercial |
$8.73
|
| Rate for Payer: Wise Provider Network Commercial |
$8.46
|
|
|
SUT ET CHROMIC 2-0 CT-1 811H
|
Facility
|
IP
|
$7.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.30
|
| Rate for Payer: Altius Commercial |
$7.30
|
| Rate for Payer: Beech Street Commercial |
$7.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.24
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.37
|
| Rate for Payer: Cigna of WY Commercial |
$7.45
|
| Rate for Payer: Entrust Commercial |
$7.22
|
| Rate for Payer: First Choice Health Commercial |
$7.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.02
|
| Rate for Payer: HealthUtah PPO |
$7.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.37
|
| Rate for Payer: Multiplan Medicare/VA |
$4.77
|
| Rate for Payer: One Health Plan of WY PPO |
$7.45
|
| Rate for Payer: PacificSource Commercial |
$6.84
|
| Rate for Payer: PHCS PPO |
$7.45
|
| Rate for Payer: Three Rivers PPO |
$5.70
|
| Rate for Payer: TriWest Veterans Administration |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare |
$5.02
|
| Rate for Payer: WINHealth Partners Commercial |
$7.22
|
| Rate for Payer: Wise Provider Network Commercial |
$7.22
|
|
|
SUT ET CHROMIC 2-0 CT-1 811H
|
Facility
|
OP
|
$7.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.45
|
| Rate for Payer: Aetna of WY Medicare |
$5.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.30
|
| Rate for Payer: Altius Commercial |
$7.30
|
| Rate for Payer: Beech Street Commercial |
$7.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.24
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.37
|
| Rate for Payer: Cigna of WY Commercial |
$7.45
|
| Rate for Payer: Entrust Commercial |
$7.22
|
| Rate for Payer: First Choice Health Commercial |
$7.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.41
|
| Rate for Payer: HealthUtah PPO |
$7.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.37
|
| Rate for Payer: Multiplan Medicare/VA |
$4.19
|
| Rate for Payer: One Health Plan of WY PPO |
$7.45
|
| Rate for Payer: PacificSource Commercial |
$6.84
|
| Rate for Payer: PHCS PPO |
$7.45
|
| Rate for Payer: Three Rivers PPO |
$5.70
|
| Rate for Payer: TriWest Veterans Administration |
$4.41
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare |
$4.41
|
| Rate for Payer: WINHealth Partners Commercial |
$7.45
|
| Rate for Payer: Wise Provider Network Commercial |
$7.22
|
|
|
SUT ET CHROMIC 3-0 SH G122
|
Facility
|
IP
|
$8.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.69
|
| Rate for Payer: Altius Commercial |
$7.69
|
| Rate for Payer: Beech Street Commercial |
$7.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.58
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.77
|
| Rate for Payer: Cigna of WY Commercial |
$7.85
|
| Rate for Payer: Entrust Commercial |
$7.61
|
| Rate for Payer: First Choice Health Commercial |
$7.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.29
|
| Rate for Payer: HealthUtah PPO |
$8.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.77
|
| Rate for Payer: Multiplan Medicare/VA |
$5.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.85
|
| Rate for Payer: PacificSource Commercial |
$7.21
|
| Rate for Payer: PHCS PPO |
$7.85
|
| Rate for Payer: Three Rivers PPO |
$6.01
|
| Rate for Payer: TriWest Veterans Administration |
$5.29
|
| Rate for Payer: United Healthcare Commercial |
$6.97
|
| Rate for Payer: United Healthcare Medicare |
$5.29
|
| Rate for Payer: WINHealth Partners Commercial |
$7.61
|
| Rate for Payer: Wise Provider Network Commercial |
$7.61
|
|
|
SUT ET CHROMIC 3-0 SH G122
|
Facility
|
OP
|
$8.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.85
|
| Rate for Payer: Aetna of WY Medicare |
$5.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.69
|
| Rate for Payer: Altius Commercial |
$7.69
|
| Rate for Payer: Beech Street Commercial |
$7.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.58
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.77
|
| Rate for Payer: Cigna of WY Commercial |
$7.85
|
| Rate for Payer: Entrust Commercial |
$7.61
|
| Rate for Payer: First Choice Health Commercial |
$7.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.65
|
| Rate for Payer: HealthUtah PPO |
$8.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.77
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$7.85
|
| Rate for Payer: PacificSource Commercial |
$7.21
|
| Rate for Payer: PHCS PPO |
$7.85
|
| Rate for Payer: Three Rivers PPO |
$6.01
|
| Rate for Payer: TriWest Veterans Administration |
$4.65
|
| Rate for Payer: United Healthcare Commercial |
$6.97
|
| Rate for Payer: United Healthcare Medicare |
$4.65
|
| Rate for Payer: WINHealth Partners Commercial |
$7.85
|
| Rate for Payer: Wise Provider Network Commercial |
$7.61
|
|
|
SUT ET CHROMIC 3-0 V-34 942H
|
Facility
|
OP
|
$13.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.05
|
| Rate for Payer: Aetna of WY Medicare |
$8.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.79
|
| Rate for Payer: Altius Commercial |
$12.79
|
| Rate for Payer: Beech Street Commercial |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.92
|
| Rate for Payer: Cigna of WY Commercial |
$13.05
|
| Rate for Payer: Entrust Commercial |
$12.65
|
| Rate for Payer: First Choice Health Commercial |
$12.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.73
|
| Rate for Payer: HealthUtah PPO |
$13.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.92
|
| Rate for Payer: Multiplan Medicare/VA |
$7.34
|
| Rate for Payer: One Health Plan of WY PPO |
$13.05
|
| Rate for Payer: PacificSource Commercial |
$11.99
|
| Rate for Payer: PHCS PPO |
$13.05
|
| Rate for Payer: Three Rivers PPO |
$9.99
|
| Rate for Payer: TriWest Veterans Administration |
$7.73
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare |
$7.73
|
| Rate for Payer: WINHealth Partners Commercial |
$13.05
|
| Rate for Payer: Wise Provider Network Commercial |
$12.65
|
|
|
SUT ET CHROMIC 3-0 V-34 942H
|
Facility
|
IP
|
$13.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.79
|
| Rate for Payer: Altius Commercial |
$12.79
|
| Rate for Payer: Beech Street Commercial |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.92
|
| Rate for Payer: Cigna of WY Commercial |
$13.05
|
| Rate for Payer: Entrust Commercial |
$12.65
|
| Rate for Payer: First Choice Health Commercial |
$12.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.79
|
| Rate for Payer: HealthUtah PPO |
$13.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.35
|
| Rate for Payer: One Health Plan of WY PPO |
$13.05
|
| Rate for Payer: PacificSource Commercial |
$11.99
|
| Rate for Payer: PHCS PPO |
$13.05
|
| Rate for Payer: Three Rivers PPO |
$9.99
|
| Rate for Payer: TriWest Veterans Administration |
$8.79
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare |
$8.79
|
| Rate for Payer: WINHealth Partners Commercial |
$12.65
|
| Rate for Payer: Wise Provider Network Commercial |
$12.65
|
|
|
SUT ET CHROMIC 4-0 SH G121H
|
Facility
|
IP
|
$8.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$8.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.98
|
| Rate for Payer: Altius Commercial |
$7.98
|
| Rate for Payer: Beech Street Commercial |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.82
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.06
|
| Rate for Payer: Cigna of WY Commercial |
$8.14
|
| Rate for Payer: Entrust Commercial |
$7.89
|
| Rate for Payer: First Choice Health Commercial |
$7.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.48
|
| Rate for Payer: HealthUtah PPO |
$8.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.06
|
| Rate for Payer: Multiplan Medicare/VA |
$5.21
|
| Rate for Payer: One Health Plan of WY PPO |
$8.14
|
| Rate for Payer: PacificSource Commercial |
$7.48
|
| Rate for Payer: PHCS PPO |
$8.14
|
| Rate for Payer: Three Rivers PPO |
$6.23
|
| Rate for Payer: TriWest Veterans Administration |
$5.48
|
| Rate for Payer: United Healthcare Commercial |
$7.23
|
| Rate for Payer: United Healthcare Medicare |
$5.48
|
| Rate for Payer: WINHealth Partners Commercial |
$7.89
|
| Rate for Payer: Wise Provider Network Commercial |
$7.89
|
|
|
SUT ET CHROMIC 4-0 SH G121H
|
Facility
|
OP
|
$8.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$8.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.14
|
| Rate for Payer: Aetna of WY Medicare |
$5.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.98
|
| Rate for Payer: Altius Commercial |
$7.98
|
| Rate for Payer: Beech Street Commercial |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.82
|
| Rate for Payer: Cash Price |
$5.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.06
|
| Rate for Payer: Cigna of WY Commercial |
$8.14
|
| Rate for Payer: Entrust Commercial |
$7.89
|
| Rate for Payer: First Choice Health Commercial |
$7.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.82
|
| Rate for Payer: HealthUtah PPO |
$8.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.06
|
| Rate for Payer: Multiplan Medicare/VA |
$4.58
|
| Rate for Payer: One Health Plan of WY PPO |
$8.14
|
| Rate for Payer: PacificSource Commercial |
$7.48
|
| Rate for Payer: PHCS PPO |
$8.14
|
| Rate for Payer: Three Rivers PPO |
$6.23
|
| Rate for Payer: TriWest Veterans Administration |
$4.82
|
| Rate for Payer: United Healthcare Commercial |
$7.23
|
| Rate for Payer: United Healthcare Medicare |
$4.82
|
| Rate for Payer: WINHealth Partners Commercial |
$8.14
|
| Rate for Payer: Wise Provider Network Commercial |
$7.89
|
|
|
SUT ET EHTILON 5-0 FS-2 661G
|
Facility
|
OP
|
$4.52
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.43
|
| Rate for Payer: Aetna of WY Medicare |
$2.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.34
|
| Rate for Payer: Altius Commercial |
$4.34
|
| Rate for Payer: Beech Street Commercial |
$4.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.71
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.38
|
| Rate for Payer: Cigna of WY Commercial |
$4.43
|
| Rate for Payer: Entrust Commercial |
$4.29
|
| Rate for Payer: First Choice Health Commercial |
$4.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.62
|
| Rate for Payer: HealthUtah PPO |
$4.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.38
|
| Rate for Payer: Multiplan Medicare/VA |
$2.49
|
| Rate for Payer: One Health Plan of WY PPO |
$4.43
|
| Rate for Payer: PacificSource Commercial |
$4.07
|
| Rate for Payer: PHCS PPO |
$4.43
|
| Rate for Payer: Three Rivers PPO |
$3.39
|
| Rate for Payer: TriWest Veterans Administration |
$2.62
|
| Rate for Payer: United Healthcare Commercial |
$3.93
|
| Rate for Payer: United Healthcare Medicare |
$2.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4.43
|
| Rate for Payer: Wise Provider Network Commercial |
$4.29
|
|
|
SUT ET EHTILON 5-0 FS-2 661G
|
Facility
|
IP
|
$4.52
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.34
|
| Rate for Payer: Altius Commercial |
$4.34
|
| Rate for Payer: Beech Street Commercial |
$4.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.71
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.38
|
| Rate for Payer: Cigna of WY Commercial |
$4.43
|
| Rate for Payer: Entrust Commercial |
$4.29
|
| Rate for Payer: First Choice Health Commercial |
$4.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.98
|
| Rate for Payer: HealthUtah PPO |
$4.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.38
|
| Rate for Payer: Multiplan Medicare/VA |
$2.83
|
| Rate for Payer: One Health Plan of WY PPO |
$4.43
|
| Rate for Payer: PacificSource Commercial |
$4.07
|
| Rate for Payer: PHCS PPO |
$4.43
|
| Rate for Payer: Three Rivers PPO |
$3.39
|
| Rate for Payer: TriWest Veterans Administration |
$2.98
|
| Rate for Payer: United Healthcare Commercial |
$3.93
|
| Rate for Payer: United Healthcare Medicare |
$2.98
|
| Rate for Payer: WINHealth Partners Commercial |
$4.29
|
| Rate for Payer: Wise Provider Network Commercial |
$4.29
|
|
|
SUT ET ETHIBOND 2-0 CT-2 X411H
|
Facility
|
OP
|
$4.44
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.35
|
| Rate for Payer: Aetna of WY Medicare |
$2.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.26
|
| Rate for Payer: Altius Commercial |
$4.26
|
| Rate for Payer: Beech Street Commercial |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.65
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.31
|
| Rate for Payer: Cigna of WY Commercial |
$4.35
|
| Rate for Payer: Entrust Commercial |
$4.22
|
| Rate for Payer: First Choice Health Commercial |
$4.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.58
|
| Rate for Payer: HealthUtah PPO |
$4.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.31
|
| Rate for Payer: Multiplan Medicare/VA |
$2.45
|
| Rate for Payer: One Health Plan of WY PPO |
$4.35
|
| Rate for Payer: PacificSource Commercial |
$4.00
|
| Rate for Payer: PHCS PPO |
$4.35
|
| Rate for Payer: Three Rivers PPO |
$3.33
|
| Rate for Payer: TriWest Veterans Administration |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.86
|
| Rate for Payer: United Healthcare Medicare |
$2.58
|
| Rate for Payer: WINHealth Partners Commercial |
$4.35
|
| Rate for Payer: Wise Provider Network Commercial |
$4.22
|
|
|
SUT ET ETHIBOND 2-0 CT-2 X411H
|
Facility
|
IP
|
$4.44
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.26
|
| Rate for Payer: Altius Commercial |
$4.26
|
| Rate for Payer: Beech Street Commercial |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.65
|
| Rate for Payer: Cash Price |
$3.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.31
|
| Rate for Payer: Cigna of WY Commercial |
$4.35
|
| Rate for Payer: Entrust Commercial |
$4.22
|
| Rate for Payer: First Choice Health Commercial |
$4.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.93
|
| Rate for Payer: HealthUtah PPO |
$4.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.31
|
| Rate for Payer: Multiplan Medicare/VA |
$2.78
|
| Rate for Payer: One Health Plan of WY PPO |
$4.35
|
| Rate for Payer: PacificSource Commercial |
$4.00
|
| Rate for Payer: PHCS PPO |
$4.35
|
| Rate for Payer: Three Rivers PPO |
$3.33
|
| Rate for Payer: TriWest Veterans Administration |
$2.93
|
| Rate for Payer: United Healthcare Commercial |
$3.86
|
| Rate for Payer: United Healthcare Medicare |
$2.93
|
| Rate for Payer: WINHealth Partners Commercial |
$4.22
|
| Rate for Payer: Wise Provider Network Commercial |
$4.22
|
|
|
SUT ET ETHIBOND 2 V-37 MX69G
|
Facility
|
OP
|
$40.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$40.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.02
|
| Rate for Payer: Aetna of WY Medicare |
$26.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.21
|
| Rate for Payer: Altius Commercial |
$39.21
|
| Rate for Payer: Beech Street Commercial |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.53
|
| Rate for Payer: Cash Price |
$28.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.61
|
| Rate for Payer: Cigna of WY Commercial |
$40.02
|
| Rate for Payer: Entrust Commercial |
$38.80
|
| Rate for Payer: First Choice Health Commercial |
$38.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.69
|
| Rate for Payer: HealthUtah PPO |
$40.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.61
|
| Rate for Payer: Multiplan Medicare/VA |
$22.50
|
| Rate for Payer: One Health Plan of WY PPO |
$40.02
|
| Rate for Payer: PacificSource Commercial |
$36.76
|
| Rate for Payer: PHCS PPO |
$40.02
|
| Rate for Payer: Three Rivers PPO |
$30.63
|
| Rate for Payer: TriWest Veterans Administration |
$23.69
|
| Rate for Payer: United Healthcare Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare |
$23.69
|
| Rate for Payer: WINHealth Partners Commercial |
$40.02
|
| Rate for Payer: Wise Provider Network Commercial |
$38.80
|
|
|
SUT ET ETHIBOND 2 V-37 MX69G
|
Facility
|
IP
|
$40.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$40.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.21
|
| Rate for Payer: Altius Commercial |
$39.21
|
| Rate for Payer: Beech Street Commercial |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.53
|
| Rate for Payer: Cash Price |
$28.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.61
|
| Rate for Payer: Cigna of WY Commercial |
$40.02
|
| Rate for Payer: Entrust Commercial |
$38.80
|
| Rate for Payer: First Choice Health Commercial |
$38.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.95
|
| Rate for Payer: HealthUtah PPO |
$40.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.61
|
| Rate for Payer: Multiplan Medicare/VA |
$25.61
|
| Rate for Payer: One Health Plan of WY PPO |
$40.02
|
| Rate for Payer: PacificSource Commercial |
$36.76
|
| Rate for Payer: PHCS PPO |
$40.02
|
| Rate for Payer: Three Rivers PPO |
$30.63
|
| Rate for Payer: TriWest Veterans Administration |
$26.95
|
| Rate for Payer: United Healthcare Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare |
$26.95
|
| Rate for Payer: WINHealth Partners Commercial |
$38.80
|
| Rate for Payer: Wise Provider Network Commercial |
$38.80
|
|
|
SUT ET ETHILON 2-0 FS 664G
|
Facility
|
IP
|
$4.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.11
|
| Rate for Payer: Altius Commercial |
$4.11
|
| Rate for Payer: Beech Street Commercial |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.15
|
| Rate for Payer: Cigna of WY Commercial |
$4.19
|
| Rate for Payer: Entrust Commercial |
$4.07
|
| Rate for Payer: First Choice Health Commercial |
$4.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.82
|
| Rate for Payer: HealthUtah PPO |
$4.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.15
|
| Rate for Payer: Multiplan Medicare/VA |
$2.68
|
| Rate for Payer: One Health Plan of WY PPO |
$4.19
|
| Rate for Payer: PacificSource Commercial |
$3.85
|
| Rate for Payer: PHCS PPO |
$4.19
|
| Rate for Payer: Three Rivers PPO |
$3.21
|
| Rate for Payer: TriWest Veterans Administration |
$2.82
|
| Rate for Payer: United Healthcare Commercial |
$3.72
|
| Rate for Payer: United Healthcare Medicare |
$2.82
|
| Rate for Payer: WINHealth Partners Commercial |
$4.07
|
| Rate for Payer: Wise Provider Network Commercial |
$4.07
|
|
|
SUT ET ETHILON 2-0 FS 664G
|
Facility
|
OP
|
$4.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.19
|
| Rate for Payer: Aetna of WY Medicare |
$2.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.11
|
| Rate for Payer: Altius Commercial |
$4.11
|
| Rate for Payer: Beech Street Commercial |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.15
|
| Rate for Payer: Cigna of WY Commercial |
$4.19
|
| Rate for Payer: Entrust Commercial |
$4.07
|
| Rate for Payer: First Choice Health Commercial |
$4.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.48
|
| Rate for Payer: HealthUtah PPO |
$4.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.15
|
| Rate for Payer: Multiplan Medicare/VA |
$2.36
|
| Rate for Payer: One Health Plan of WY PPO |
$4.19
|
| Rate for Payer: PacificSource Commercial |
$3.85
|
| Rate for Payer: PHCS PPO |
$4.19
|
| Rate for Payer: Three Rivers PPO |
$3.21
|
| Rate for Payer: TriWest Veterans Administration |
$2.48
|
| Rate for Payer: United Healthcare Commercial |
$3.72
|
| Rate for Payer: United Healthcare Medicare |
$2.48
|
| Rate for Payer: WINHealth Partners Commercial |
$4.19
|
| Rate for Payer: Wise Provider Network Commercial |
$4.07
|
|
|
SUT ET ETHILON 3-0 PS-1 1663H
|
Facility
|
IP
|
$9.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.38
|
| Rate for Payer: Altius Commercial |
$9.38
|
| Rate for Payer: Beech Street Commercial |
$9.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.02
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.48
|
| Rate for Payer: Cigna of WY Commercial |
$9.57
|
| Rate for Payer: Entrust Commercial |
$9.28
|
| Rate for Payer: First Choice Health Commercial |
$9.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.45
|
| Rate for Payer: HealthUtah PPO |
$9.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.48
|
| Rate for Payer: Multiplan Medicare/VA |
$6.13
|
| Rate for Payer: One Health Plan of WY PPO |
$9.57
|
| Rate for Payer: PacificSource Commercial |
$8.79
|
| Rate for Payer: PHCS PPO |
$9.57
|
| Rate for Payer: Three Rivers PPO |
$7.33
|
| Rate for Payer: TriWest Veterans Administration |
$6.45
|
| Rate for Payer: United Healthcare Commercial |
$8.50
|
| Rate for Payer: United Healthcare Medicare |
$6.45
|
| Rate for Payer: WINHealth Partners Commercial |
$9.28
|
| Rate for Payer: Wise Provider Network Commercial |
$9.28
|
|
