|
SUT ET ETHILON 3-0 PS-1 1663H
|
Facility
|
OP
|
$9.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.57
|
| Rate for Payer: Aetna of WY Medicare |
$6.45
|
| 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 |
$5.67
|
| Rate for Payer: HealthUtah PPO |
$9.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.48
|
| Rate for Payer: Multiplan Medicare/VA |
$5.38
|
| 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 |
$5.67
|
| Rate for Payer: United Healthcare Commercial |
$8.50
|
| Rate for Payer: United Healthcare Medicare |
$5.67
|
| Rate for Payer: WINHealth Partners Commercial |
$9.57
|
| Rate for Payer: Wise Provider Network Commercial |
$9.28
|
|
|
SUT ET ETHILON 4-0 PS-2 1667H
|
Facility
|
OP
|
$8.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.77
|
| Rate for Payer: Aetna of WY Medicare |
$5.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.59
|
| Rate for Payer: Altius Commercial |
$8.59
|
| Rate for Payer: Beech Street Commercial |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.35
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.68
|
| Rate for Payer: Cigna of WY Commercial |
$8.77
|
| Rate for Payer: Entrust Commercial |
$8.50
|
| Rate for Payer: First Choice Health Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.19
|
| Rate for Payer: HealthUtah PPO |
$8.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.68
|
| Rate for Payer: Multiplan Medicare/VA |
$4.93
|
| Rate for Payer: One Health Plan of WY PPO |
$8.77
|
| Rate for Payer: PacificSource Commercial |
$8.06
|
| Rate for Payer: PHCS PPO |
$8.77
|
| Rate for Payer: Three Rivers PPO |
$6.71
|
| Rate for Payer: TriWest Veterans Administration |
$5.19
|
| Rate for Payer: United Healthcare Commercial |
$7.79
|
| Rate for Payer: United Healthcare Medicare |
$5.19
|
| Rate for Payer: WINHealth Partners Commercial |
$8.77
|
| Rate for Payer: Wise Provider Network Commercial |
$8.50
|
|
|
SUT ET ETHILON 4-0 PS-2 1667H
|
Facility
|
IP
|
$8.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.59
|
| Rate for Payer: Altius Commercial |
$8.59
|
| Rate for Payer: Beech Street Commercial |
$8.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.35
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.68
|
| Rate for Payer: Cigna of WY Commercial |
$8.77
|
| Rate for Payer: Entrust Commercial |
$8.50
|
| Rate for Payer: First Choice Health Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.91
|
| Rate for Payer: HealthUtah PPO |
$8.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.68
|
| Rate for Payer: Multiplan Medicare/VA |
$5.61
|
| Rate for Payer: One Health Plan of WY PPO |
$8.77
|
| Rate for Payer: PacificSource Commercial |
$8.06
|
| Rate for Payer: PHCS PPO |
$8.77
|
| Rate for Payer: Three Rivers PPO |
$6.71
|
| Rate for Payer: TriWest Veterans Administration |
$5.91
|
| Rate for Payer: United Healthcare Commercial |
$7.79
|
| Rate for Payer: United Healthcare Medicare |
$5.91
|
| Rate for Payer: WINHealth Partners Commercial |
$8.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8.50
|
|
|
SUT ETHILON 10-0 BV130-3 2820G
|
Facility
|
OP
|
$37.22
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.51 |
| Max. Negotiated Rate |
$37.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.48
|
| Rate for Payer: Aetna of WY Medicare |
$24.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.73
|
| Rate for Payer: Altius Commercial |
$35.73
|
| Rate for Payer: Beech Street Commercial |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.56
|
| Rate for Payer: Cash Price |
$26.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.10
|
| Rate for Payer: Cigna of WY Commercial |
$36.48
|
| Rate for Payer: Entrust Commercial |
$35.36
|
| Rate for Payer: First Choice Health Commercial |
$35.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.59
|
| Rate for Payer: HealthUtah PPO |
$37.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.10
|
| Rate for Payer: Multiplan Medicare/VA |
$20.51
|
| Rate for Payer: One Health Plan of WY PPO |
$36.48
|
| Rate for Payer: PacificSource Commercial |
$33.50
|
| Rate for Payer: PHCS PPO |
$36.48
|
| Rate for Payer: Three Rivers PPO |
$27.92
|
| Rate for Payer: TriWest Veterans Administration |
$21.59
|
| Rate for Payer: United Healthcare Commercial |
$32.38
|
| Rate for Payer: United Healthcare Medicare |
$21.59
|
| Rate for Payer: WINHealth Partners Commercial |
$36.48
|
| Rate for Payer: Wise Provider Network Commercial |
$35.36
|
|
|
SUT ETHILON 10-0 BV130-3 2820G
|
Facility
|
IP
|
$37.22
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$37.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.73
|
| Rate for Payer: Altius Commercial |
$35.73
|
| Rate for Payer: Beech Street Commercial |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.56
|
| Rate for Payer: Cash Price |
$26.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.10
|
| Rate for Payer: Cigna of WY Commercial |
$36.48
|
| Rate for Payer: Entrust Commercial |
$35.36
|
| Rate for Payer: First Choice Health Commercial |
$35.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.57
|
| Rate for Payer: HealthUtah PPO |
$37.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.10
|
| Rate for Payer: Multiplan Medicare/VA |
$23.34
|
| Rate for Payer: One Health Plan of WY PPO |
$36.48
|
| Rate for Payer: PacificSource Commercial |
$33.50
|
| Rate for Payer: PHCS PPO |
$36.48
|
| Rate for Payer: Three Rivers PPO |
$27.92
|
| Rate for Payer: TriWest Veterans Administration |
$24.57
|
| Rate for Payer: United Healthcare Commercial |
$32.38
|
| Rate for Payer: United Healthcare Medicare |
$24.57
|
| Rate for Payer: WINHealth Partners Commercial |
$35.36
|
| Rate for Payer: Wise Provider Network Commercial |
$35.36
|
|
|
SUT ETHILON 3-0 PSL 30"
|
Facility
|
IP
|
$8.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.50
|
| Rate for Payer: Altius Commercial |
$8.50
|
| Rate for Payer: Beech Street Commercial |
$8.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.27
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.58
|
| Rate for Payer: Cigna of WY Commercial |
$8.67
|
| Rate for Payer: Entrust Commercial |
$8.41
|
| Rate for Payer: First Choice Health Commercial |
$8.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.84
|
| Rate for Payer: HealthUtah PPO |
$8.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.58
|
| Rate for Payer: Multiplan Medicare/VA |
$5.55
|
| Rate for Payer: One Health Plan of WY PPO |
$8.67
|
| Rate for Payer: PacificSource Commercial |
$7.96
|
| Rate for Payer: PHCS PPO |
$8.67
|
| Rate for Payer: Three Rivers PPO |
$6.64
|
| Rate for Payer: TriWest Veterans Administration |
$5.84
|
| Rate for Payer: United Healthcare Commercial |
$7.70
|
| Rate for Payer: United Healthcare Medicare |
$5.84
|
| Rate for Payer: WINHealth Partners Commercial |
$8.41
|
| Rate for Payer: Wise Provider Network Commercial |
$8.41
|
|
|
SUT ETHILON 3-0 PSL 30"
|
Facility
|
OP
|
$8.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.67
|
| Rate for Payer: Aetna of WY Medicare |
$5.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.50
|
| Rate for Payer: Altius Commercial |
$8.50
|
| Rate for Payer: Beech Street Commercial |
$8.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.27
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.58
|
| Rate for Payer: Cigna of WY Commercial |
$8.67
|
| Rate for Payer: Entrust Commercial |
$8.41
|
| Rate for Payer: First Choice Health Commercial |
$8.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.13
|
| Rate for Payer: HealthUtah PPO |
$8.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.58
|
| Rate for Payer: Multiplan Medicare/VA |
$4.88
|
| Rate for Payer: One Health Plan of WY PPO |
$8.67
|
| Rate for Payer: PacificSource Commercial |
$7.96
|
| Rate for Payer: PHCS PPO |
$8.67
|
| Rate for Payer: Three Rivers PPO |
$6.64
|
| Rate for Payer: TriWest Veterans Administration |
$5.13
|
| Rate for Payer: United Healthcare Commercial |
$7.70
|
| Rate for Payer: United Healthcare Medicare |
$5.13
|
| Rate for Payer: WINHealth Partners Commercial |
$8.67
|
| Rate for Payer: Wise Provider Network Commercial |
$8.41
|
|
|
SUT ETHILON 8-0 BV130-3 2822G
|
Facility
|
OP
|
$33.66
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.99
|
| Rate for Payer: Aetna of WY Medicare |
$22.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.31
|
| Rate for Payer: Altius Commercial |
$32.31
|
| Rate for Payer: Beech Street Commercial |
$32.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.63
|
| Rate for Payer: Cash Price |
$23.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.65
|
| Rate for Payer: Cigna of WY Commercial |
$32.99
|
| Rate for Payer: Entrust Commercial |
$31.98
|
| Rate for Payer: First Choice Health Commercial |
$31.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.52
|
| Rate for Payer: HealthUtah PPO |
$33.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.65
|
| Rate for Payer: Multiplan Medicare/VA |
$18.55
|
| Rate for Payer: One Health Plan of WY PPO |
$32.99
|
| Rate for Payer: PacificSource Commercial |
$30.29
|
| Rate for Payer: PHCS PPO |
$32.99
|
| Rate for Payer: Three Rivers PPO |
$25.24
|
| Rate for Payer: TriWest Veterans Administration |
$19.52
|
| Rate for Payer: United Healthcare Commercial |
$29.28
|
| Rate for Payer: United Healthcare Medicare |
$19.52
|
| Rate for Payer: WINHealth Partners Commercial |
$32.99
|
| Rate for Payer: Wise Provider Network Commercial |
$31.98
|
|
|
SUT ETHILON 8-0 BV130-3 2822G
|
Facility
|
IP
|
$33.66
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.31
|
| Rate for Payer: Altius Commercial |
$32.31
|
| Rate for Payer: Beech Street Commercial |
$32.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.63
|
| Rate for Payer: Cash Price |
$23.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.65
|
| Rate for Payer: Cigna of WY Commercial |
$32.99
|
| Rate for Payer: Entrust Commercial |
$31.98
|
| Rate for Payer: First Choice Health Commercial |
$31.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.22
|
| Rate for Payer: HealthUtah PPO |
$33.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.65
|
| Rate for Payer: Multiplan Medicare/VA |
$21.10
|
| Rate for Payer: One Health Plan of WY PPO |
$32.99
|
| Rate for Payer: PacificSource Commercial |
$30.29
|
| Rate for Payer: PHCS PPO |
$32.99
|
| Rate for Payer: Three Rivers PPO |
$25.24
|
| Rate for Payer: TriWest Veterans Administration |
$22.22
|
| Rate for Payer: United Healthcare Commercial |
$29.28
|
| Rate for Payer: United Healthcare Medicare |
$22.22
|
| Rate for Payer: WINHealth Partners Commercial |
$31.98
|
| Rate for Payer: Wise Provider Network Commercial |
$31.98
|
|
|
SUT ETHILON 9-0 BV130-3 2819G
|
Facility
|
OP
|
$34.26
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.57
|
| Rate for Payer: Aetna of WY Medicare |
$22.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.89
|
| Rate for Payer: Altius Commercial |
$32.89
|
| Rate for Payer: Beech Street Commercial |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.13
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.23
|
| Rate for Payer: Cigna of WY Commercial |
$33.57
|
| Rate for Payer: Entrust Commercial |
$32.55
|
| Rate for Payer: First Choice Health Commercial |
$32.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.87
|
| Rate for Payer: HealthUtah PPO |
$34.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.23
|
| Rate for Payer: Multiplan Medicare/VA |
$18.88
|
| Rate for Payer: One Health Plan of WY PPO |
$33.57
|
| Rate for Payer: PacificSource Commercial |
$30.83
|
| Rate for Payer: PHCS PPO |
$33.57
|
| Rate for Payer: Three Rivers PPO |
$25.70
|
| Rate for Payer: TriWest Veterans Administration |
$19.87
|
| Rate for Payer: United Healthcare Commercial |
$29.81
|
| Rate for Payer: United Healthcare Medicare |
$19.87
|
| Rate for Payer: WINHealth Partners Commercial |
$33.57
|
| Rate for Payer: Wise Provider Network Commercial |
$32.55
|
|
|
SUT ETHILON 9-0 BV130-3 2819G
|
Facility
|
IP
|
$34.26
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.89
|
| Rate for Payer: Altius Commercial |
$32.89
|
| Rate for Payer: Beech Street Commercial |
$33.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.13
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.23
|
| Rate for Payer: Cigna of WY Commercial |
$33.57
|
| Rate for Payer: Entrust Commercial |
$32.55
|
| Rate for Payer: First Choice Health Commercial |
$32.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.61
|
| Rate for Payer: HealthUtah PPO |
$34.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.23
|
| Rate for Payer: Multiplan Medicare/VA |
$21.48
|
| Rate for Payer: One Health Plan of WY PPO |
$33.57
|
| Rate for Payer: PacificSource Commercial |
$30.83
|
| Rate for Payer: PHCS PPO |
$33.57
|
| Rate for Payer: Three Rivers PPO |
$25.70
|
| Rate for Payer: TriWest Veterans Administration |
$22.61
|
| Rate for Payer: United Healthcare Commercial |
$29.81
|
| Rate for Payer: United Healthcare Medicare |
$22.61
|
| Rate for Payer: WINHealth Partners Commercial |
$32.55
|
| Rate for Payer: Wise Provider Network Commercial |
$32.55
|
|
|
SUT ET MERSILENE 2-0 FS 18"
|
Facility
|
IP
|
$5.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.28
|
| Rate for Payer: Altius Commercial |
$5.28
|
| Rate for Payer: Beech Street Commercial |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.52
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.34
|
| Rate for Payer: Cigna of WY Commercial |
$5.39
|
| Rate for Payer: Entrust Commercial |
$5.22
|
| Rate for Payer: First Choice Health Commercial |
$5.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.63
|
| Rate for Payer: HealthUtah PPO |
$5.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.34
|
| Rate for Payer: Multiplan Medicare/VA |
$3.45
|
| Rate for Payer: One Health Plan of WY PPO |
$5.39
|
| Rate for Payer: PacificSource Commercial |
$4.95
|
| Rate for Payer: PHCS PPO |
$5.39
|
| Rate for Payer: Three Rivers PPO |
$4.12
|
| Rate for Payer: TriWest Veterans Administration |
$3.63
|
| Rate for Payer: United Healthcare Commercial |
$4.78
|
| Rate for Payer: United Healthcare Medicare |
$3.63
|
| Rate for Payer: WINHealth Partners Commercial |
$5.22
|
| Rate for Payer: Wise Provider Network Commercial |
$5.22
|
|
|
SUT ET MERSILENE 2-0 FS 18"
|
Facility
|
OP
|
$5.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.39
|
| Rate for Payer: Aetna of WY Medicare |
$3.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.28
|
| Rate for Payer: Altius Commercial |
$5.28
|
| Rate for Payer: Beech Street Commercial |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.52
|
| Rate for Payer: Cash Price |
$3.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.34
|
| Rate for Payer: Cigna of WY Commercial |
$5.39
|
| Rate for Payer: Entrust Commercial |
$5.22
|
| Rate for Payer: First Choice Health Commercial |
$5.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.19
|
| Rate for Payer: HealthUtah PPO |
$5.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.34
|
| Rate for Payer: Multiplan Medicare/VA |
$3.03
|
| Rate for Payer: One Health Plan of WY PPO |
$5.39
|
| Rate for Payer: PacificSource Commercial |
$4.95
|
| Rate for Payer: PHCS PPO |
$5.39
|
| Rate for Payer: Three Rivers PPO |
$4.12
|
| Rate for Payer: TriWest Veterans Administration |
$3.19
|
| Rate for Payer: United Healthcare Commercial |
$4.78
|
| Rate for Payer: United Healthcare Medicare |
$3.19
|
| Rate for Payer: WINHealth Partners Commercial |
$5.39
|
| Rate for Payer: Wise Provider Network Commercial |
$5.22
|
|
|
SUT ET MERSILENE 3-0 FS-1 18"
|
Facility
|
IP
|
$5.42
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.20
|
| Rate for Payer: Altius Commercial |
$5.20
|
| Rate for Payer: Beech Street Commercial |
$5.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.26
|
| Rate for Payer: Cigna of WY Commercial |
$5.31
|
| Rate for Payer: Entrust Commercial |
$5.15
|
| Rate for Payer: First Choice Health Commercial |
$5.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.58
|
| Rate for Payer: HealthUtah PPO |
$5.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.26
|
| Rate for Payer: Multiplan Medicare/VA |
$3.40
|
| Rate for Payer: One Health Plan of WY PPO |
$5.31
|
| Rate for Payer: PacificSource Commercial |
$4.88
|
| Rate for Payer: PHCS PPO |
$5.31
|
| Rate for Payer: Three Rivers PPO |
$4.06
|
| Rate for Payer: TriWest Veterans Administration |
$3.58
|
| Rate for Payer: United Healthcare Commercial |
$4.72
|
| Rate for Payer: United Healthcare Medicare |
$3.58
|
| Rate for Payer: WINHealth Partners Commercial |
$5.15
|
| Rate for Payer: Wise Provider Network Commercial |
$5.15
|
|
|
SUT ET MERSILENE 3-0 FS-1 18"
|
Facility
|
OP
|
$5.42
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.31
|
| Rate for Payer: Aetna of WY Medicare |
$3.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.20
|
| Rate for Payer: Altius Commercial |
$5.20
|
| Rate for Payer: Beech Street Commercial |
$5.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.26
|
| Rate for Payer: Cigna of WY Commercial |
$5.31
|
| Rate for Payer: Entrust Commercial |
$5.15
|
| Rate for Payer: First Choice Health Commercial |
$5.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.14
|
| Rate for Payer: HealthUtah PPO |
$5.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.26
|
| Rate for Payer: Multiplan Medicare/VA |
$2.99
|
| Rate for Payer: One Health Plan of WY PPO |
$5.31
|
| Rate for Payer: PacificSource Commercial |
$4.88
|
| Rate for Payer: PHCS PPO |
$5.31
|
| Rate for Payer: Three Rivers PPO |
$4.06
|
| Rate for Payer: TriWest Veterans Administration |
$3.14
|
| Rate for Payer: United Healthcare Commercial |
$4.72
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WINHealth Partners Commercial |
$5.31
|
| Rate for Payer: Wise Provider Network Commercial |
$5.15
|
|
|
SUT ET MONOCRYL 0 CT-1 MCP346H
|
Facility
|
IP
|
$6.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.07
|
| Rate for Payer: Altius Commercial |
$6.07
|
| Rate for Payer: Beech Street Commercial |
$6.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.19
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.13
|
| Rate for Payer: Cigna of WY Commercial |
$6.19
|
| Rate for Payer: Entrust Commercial |
$6.00
|
| Rate for Payer: First Choice Health Commercial |
$6.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.17
|
| Rate for Payer: HealthUtah PPO |
$6.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.13
|
| Rate for Payer: Multiplan Medicare/VA |
$3.96
|
| Rate for Payer: One Health Plan of WY PPO |
$6.19
|
| Rate for Payer: PacificSource Commercial |
$5.69
|
| Rate for Payer: PHCS PPO |
$6.19
|
| Rate for Payer: Three Rivers PPO |
$4.74
|
| Rate for Payer: TriWest Veterans Administration |
$4.17
|
| Rate for Payer: United Healthcare Commercial |
$5.50
|
| Rate for Payer: United Healthcare Medicare |
$4.17
|
| Rate for Payer: WINHealth Partners Commercial |
$6.00
|
| Rate for Payer: Wise Provider Network Commercial |
$6.00
|
|
|
SUT ET MONOCRYL 0 CT-1 MCP346H
|
Facility
|
OP
|
$6.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$6.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.19
|
| Rate for Payer: Aetna of WY Medicare |
$4.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.07
|
| Rate for Payer: Altius Commercial |
$6.07
|
| Rate for Payer: Beech Street Commercial |
$6.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.19
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.13
|
| Rate for Payer: Cigna of WY Commercial |
$6.19
|
| Rate for Payer: Entrust Commercial |
$6.00
|
| Rate for Payer: First Choice Health Commercial |
$6.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.67
|
| Rate for Payer: HealthUtah PPO |
$6.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.13
|
| Rate for Payer: Multiplan Medicare/VA |
$3.48
|
| Rate for Payer: One Health Plan of WY PPO |
$6.19
|
| Rate for Payer: PacificSource Commercial |
$5.69
|
| Rate for Payer: PHCS PPO |
$6.19
|
| Rate for Payer: Three Rivers PPO |
$4.74
|
| Rate for Payer: TriWest Veterans Administration |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$5.50
|
| Rate for Payer: United Healthcare Medicare |
$3.67
|
| Rate for Payer: WINHealth Partners Commercial |
$6.19
|
| Rate for Payer: Wise Provider Network Commercial |
$6.00
|
|
|
SUT ET MONOCRYL 1 CTX Y399H
|
Facility
|
IP
|
$5.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.73
|
| Rate for Payer: Altius Commercial |
$5.73
|
| Rate for Payer: Beech Street Commercial |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.79
|
| Rate for Payer: Cigna of WY Commercial |
$5.85
|
| Rate for Payer: Entrust Commercial |
$5.67
|
| Rate for Payer: First Choice Health Commercial |
$5.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.94
|
| Rate for Payer: HealthUtah PPO |
$5.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.79
|
| Rate for Payer: Multiplan Medicare/VA |
$3.74
|
| Rate for Payer: One Health Plan of WY PPO |
$5.85
|
| Rate for Payer: PacificSource Commercial |
$5.37
|
| Rate for Payer: PHCS PPO |
$5.85
|
| Rate for Payer: Three Rivers PPO |
$4.48
|
| Rate for Payer: TriWest Veterans Administration |
$3.94
|
| Rate for Payer: United Healthcare Commercial |
$5.19
|
| Rate for Payer: United Healthcare Medicare |
$3.94
|
| Rate for Payer: WINHealth Partners Commercial |
$5.67
|
| Rate for Payer: Wise Provider Network Commercial |
$5.67
|
|
|
SUT ET MONOCRYL 1 CTX Y399H
|
Facility
|
OP
|
$5.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.85
|
| Rate for Payer: Aetna of WY Medicare |
$3.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.73
|
| Rate for Payer: Altius Commercial |
$5.73
|
| Rate for Payer: Beech Street Commercial |
$5.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.90
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.79
|
| Rate for Payer: Cigna of WY Commercial |
$5.85
|
| Rate for Payer: Entrust Commercial |
$5.67
|
| Rate for Payer: First Choice Health Commercial |
$5.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.46
|
| Rate for Payer: HealthUtah PPO |
$5.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.79
|
| Rate for Payer: Multiplan Medicare/VA |
$3.29
|
| Rate for Payer: One Health Plan of WY PPO |
$5.85
|
| Rate for Payer: PacificSource Commercial |
$5.37
|
| Rate for Payer: PHCS PPO |
$5.85
|
| Rate for Payer: Three Rivers PPO |
$4.48
|
| Rate for Payer: TriWest Veterans Administration |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$5.19
|
| Rate for Payer: United Healthcare Medicare |
$3.46
|
| Rate for Payer: WINHealth Partners Commercial |
$5.85
|
| Rate for Payer: Wise Provider Network Commercial |
$5.67
|
|
|
SUT ET MONOCRYL 2-0 Y932H
|
Facility
|
OP
|
$10.06
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.86
|
| Rate for Payer: Aetna of WY Medicare |
$6.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.66
|
| Rate for Payer: Altius Commercial |
$9.66
|
| Rate for Payer: Beech Street Commercial |
$9.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.26
|
| Rate for Payer: Cash Price |
$7.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.76
|
| Rate for Payer: Cigna of WY Commercial |
$9.86
|
| Rate for Payer: Entrust Commercial |
$9.56
|
| Rate for Payer: First Choice Health Commercial |
$9.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.83
|
| Rate for Payer: HealthUtah PPO |
$10.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.76
|
| Rate for Payer: Multiplan Medicare/VA |
$5.54
|
| Rate for Payer: One Health Plan of WY PPO |
$9.86
|
| Rate for Payer: PacificSource Commercial |
$9.05
|
| Rate for Payer: PHCS PPO |
$9.86
|
| Rate for Payer: Three Rivers PPO |
$7.54
|
| Rate for Payer: TriWest Veterans Administration |
$5.83
|
| Rate for Payer: United Healthcare Commercial |
$8.75
|
| Rate for Payer: United Healthcare Medicare |
$5.83
|
| Rate for Payer: WINHealth Partners Commercial |
$9.86
|
| Rate for Payer: Wise Provider Network Commercial |
$9.56
|
|
|
SUT ET MONOCRYL 2-0 Y932H
|
Facility
|
IP
|
$10.06
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.66
|
| Rate for Payer: Altius Commercial |
$9.66
|
| Rate for Payer: Beech Street Commercial |
$9.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.26
|
| Rate for Payer: Cash Price |
$7.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.76
|
| Rate for Payer: Cigna of WY Commercial |
$9.86
|
| Rate for Payer: Entrust Commercial |
$9.56
|
| Rate for Payer: First Choice Health Commercial |
$9.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.64
|
| Rate for Payer: HealthUtah PPO |
$10.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.76
|
| Rate for Payer: Multiplan Medicare/VA |
$6.31
|
| Rate for Payer: One Health Plan of WY PPO |
$9.86
|
| Rate for Payer: PacificSource Commercial |
$9.05
|
| Rate for Payer: PHCS PPO |
$9.86
|
| Rate for Payer: Three Rivers PPO |
$7.54
|
| Rate for Payer: TriWest Veterans Administration |
$6.64
|
| Rate for Payer: United Healthcare Commercial |
$8.75
|
| Rate for Payer: United Healthcare Medicare |
$6.64
|
| Rate for Payer: WINHealth Partners Commercial |
$9.56
|
| Rate for Payer: Wise Provider Network Commercial |
$9.56
|
|
|
SUT ET MONOCRYL 3-0 RB-1 Y215H
|
Facility
|
OP
|
$5.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.47
|
| Rate for Payer: Aetna of WY Medicare |
$3.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.36
|
| Rate for Payer: Altius Commercial |
$5.36
|
| Rate for Payer: Beech Street Commercial |
$5.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.58
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.41
|
| Rate for Payer: Cigna of WY Commercial |
$5.47
|
| Rate for Payer: Entrust Commercial |
$5.30
|
| Rate for Payer: First Choice Health Commercial |
$5.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.24
|
| Rate for Payer: HealthUtah PPO |
$5.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.41
|
| Rate for Payer: Multiplan Medicare/VA |
$3.07
|
| Rate for Payer: One Health Plan of WY PPO |
$5.47
|
| Rate for Payer: PacificSource Commercial |
$5.02
|
| Rate for Payer: PHCS PPO |
$5.47
|
| Rate for Payer: Three Rivers PPO |
$4.18
|
| Rate for Payer: TriWest Veterans Administration |
$3.24
|
| Rate for Payer: United Healthcare Commercial |
$4.85
|
| Rate for Payer: United Healthcare Medicare |
$3.24
|
| Rate for Payer: WINHealth Partners Commercial |
$5.47
|
| Rate for Payer: Wise Provider Network Commercial |
$5.30
|
|
|
SUT ET MONOCRYL 3-0 RB-1 Y215H
|
Facility
|
IP
|
$5.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.36
|
| Rate for Payer: Altius Commercial |
$5.36
|
| Rate for Payer: Beech Street Commercial |
$5.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.58
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.41
|
| Rate for Payer: Cigna of WY Commercial |
$5.47
|
| Rate for Payer: Entrust Commercial |
$5.30
|
| Rate for Payer: First Choice Health Commercial |
$5.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.68
|
| Rate for Payer: HealthUtah PPO |
$5.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.41
|
| Rate for Payer: Multiplan Medicare/VA |
$3.50
|
| Rate for Payer: One Health Plan of WY PPO |
$5.47
|
| Rate for Payer: PacificSource Commercial |
$5.02
|
| Rate for Payer: PHCS PPO |
$5.47
|
| Rate for Payer: Three Rivers PPO |
$4.18
|
| Rate for Payer: TriWest Veterans Administration |
$3.68
|
| Rate for Payer: United Healthcare Commercial |
$4.85
|
| Rate for Payer: United Healthcare Medicare |
$3.68
|
| Rate for Payer: WINHealth Partners Commercial |
$5.30
|
| Rate for Payer: Wise Provider Network Commercial |
$5.30
|
|
|
SUT ET PDS 0 CT-2 PDP334H
|
Facility
|
IP
|
$7.27
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$7.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.98
|
| Rate for Payer: Altius Commercial |
$6.98
|
| Rate for Payer: Beech Street Commercial |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.97
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.05
|
| Rate for Payer: Cigna of WY Commercial |
$7.12
|
| Rate for Payer: Entrust Commercial |
$6.91
|
| Rate for Payer: First Choice Health Commercial |
$6.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.80
|
| Rate for Payer: HealthUtah PPO |
$7.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.05
|
| Rate for Payer: Multiplan Medicare/VA |
$4.56
|
| Rate for Payer: One Health Plan of WY PPO |
$7.12
|
| Rate for Payer: PacificSource Commercial |
$6.54
|
| Rate for Payer: PHCS PPO |
$7.12
|
| Rate for Payer: Three Rivers PPO |
$5.45
|
| Rate for Payer: TriWest Veterans Administration |
$4.80
|
| Rate for Payer: United Healthcare Commercial |
$6.32
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6.91
|
| Rate for Payer: Wise Provider Network Commercial |
$6.91
|
|
|
SUT ET PDS 0 CT-2 PDP334H
|
Facility
|
OP
|
$7.27
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$7.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.12
|
| Rate for Payer: Aetna of WY Medicare |
$4.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.98
|
| Rate for Payer: Altius Commercial |
$6.98
|
| Rate for Payer: Beech Street Commercial |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.97
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.05
|
| Rate for Payer: Cigna of WY Commercial |
$7.12
|
| Rate for Payer: Entrust Commercial |
$6.91
|
| Rate for Payer: First Choice Health Commercial |
$6.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$7.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.05
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$7.12
|
| Rate for Payer: PacificSource Commercial |
$6.54
|
| Rate for Payer: PHCS PPO |
$7.12
|
| Rate for Payer: Three Rivers PPO |
$5.45
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$6.32
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$7.12
|
| Rate for Payer: Wise Provider Network Commercial |
$6.91
|
|
