|
SUT ET PDS 1 TP-I LOOPED Z880G
|
Facility
|
IP
|
$12.07
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$12.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.59
|
| Rate for Payer: Altius Commercial |
$11.59
|
| Rate for Payer: Beech Street Commercial |
$11.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.91
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.71
|
| Rate for Payer: Cigna of WY Commercial |
$11.83
|
| Rate for Payer: Entrust Commercial |
$11.47
|
| Rate for Payer: First Choice Health Commercial |
$11.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.97
|
| Rate for Payer: HealthUtah PPO |
$12.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.71
|
| Rate for Payer: Multiplan Medicare/VA |
$7.57
|
| Rate for Payer: One Health Plan of WY PPO |
$11.83
|
| Rate for Payer: PacificSource Commercial |
$10.86
|
| Rate for Payer: PHCS PPO |
$11.83
|
| Rate for Payer: Three Rivers PPO |
$9.05
|
| Rate for Payer: TriWest Veterans Administration |
$7.97
|
| Rate for Payer: United Healthcare Commercial |
$10.50
|
| Rate for Payer: United Healthcare Medicare |
$7.97
|
| Rate for Payer: WINHealth Partners Commercial |
$11.47
|
| Rate for Payer: Wise Provider Network Commercial |
$11.47
|
|
|
SUT ET PDS 1 TP-I LOOPED Z880G
|
Facility
|
OP
|
$12.07
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$12.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.83
|
| Rate for Payer: Aetna of WY Medicare |
$7.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.59
|
| Rate for Payer: Altius Commercial |
$11.59
|
| Rate for Payer: Beech Street Commercial |
$11.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.91
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.71
|
| Rate for Payer: Cigna of WY Commercial |
$11.83
|
| Rate for Payer: Entrust Commercial |
$11.47
|
| Rate for Payer: First Choice Health Commercial |
$11.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.00
|
| Rate for Payer: HealthUtah PPO |
$12.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.71
|
| Rate for Payer: Multiplan Medicare/VA |
$6.65
|
| Rate for Payer: One Health Plan of WY PPO |
$11.83
|
| Rate for Payer: PacificSource Commercial |
$10.86
|
| Rate for Payer: PHCS PPO |
$11.83
|
| Rate for Payer: Three Rivers PPO |
$9.05
|
| Rate for Payer: TriWest Veterans Administration |
$7.00
|
| Rate for Payer: United Healthcare Commercial |
$10.50
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WINHealth Partners Commercial |
$11.83
|
| Rate for Payer: Wise Provider Network Commercial |
$11.47
|
|
|
SUT ET PDS 2-0 CT 36 Z357H
|
Facility
|
IP
|
$7.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.76
|
| Rate for Payer: Altius Commercial |
$6.76
|
| Rate for Payer: Beech Street Commercial |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.78
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.83
|
| Rate for Payer: Cigna of WY Commercial |
$6.90
|
| Rate for Payer: Entrust Commercial |
$6.69
|
| Rate for Payer: First Choice Health Commercial |
$6.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.65
|
| Rate for Payer: HealthUtah PPO |
$7.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.83
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$6.90
|
| Rate for Payer: PacificSource Commercial |
$6.34
|
| Rate for Payer: PHCS PPO |
$6.90
|
| Rate for Payer: Three Rivers PPO |
$5.28
|
| Rate for Payer: TriWest Veterans Administration |
$4.65
|
| Rate for Payer: United Healthcare Commercial |
$6.12
|
| Rate for Payer: United Healthcare Medicare |
$4.65
|
| Rate for Payer: WINHealth Partners Commercial |
$6.69
|
| Rate for Payer: Wise Provider Network Commercial |
$6.69
|
|
|
SUT ET PDS 2-0 CT 36 Z357H
|
Facility
|
OP
|
$7.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.90
|
| Rate for Payer: Aetna of WY Medicare |
$4.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.76
|
| Rate for Payer: Altius Commercial |
$6.76
|
| Rate for Payer: Beech Street Commercial |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.78
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.83
|
| Rate for Payer: Cigna of WY Commercial |
$6.90
|
| Rate for Payer: Entrust Commercial |
$6.69
|
| Rate for Payer: First Choice Health Commercial |
$6.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.08
|
| Rate for Payer: HealthUtah PPO |
$7.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.83
|
| Rate for Payer: Multiplan Medicare/VA |
$3.88
|
| Rate for Payer: One Health Plan of WY PPO |
$6.90
|
| Rate for Payer: PacificSource Commercial |
$6.34
|
| Rate for Payer: PHCS PPO |
$6.90
|
| Rate for Payer: Three Rivers PPO |
$5.28
|
| Rate for Payer: TriWest Veterans Administration |
$4.08
|
| Rate for Payer: United Healthcare Commercial |
$6.12
|
| Rate for Payer: United Healthcare Medicare |
$4.08
|
| Rate for Payer: WINHealth Partners Commercial |
$6.90
|
| Rate for Payer: Wise Provider Network Commercial |
$6.69
|
|
|
SUT ET PDS II 3-0 CT-1 Z338H
|
Facility
|
OP
|
$6.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.66
|
| Rate for Payer: Aetna of WY Medicare |
$4.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.53
|
| Rate for Payer: Altius Commercial |
$6.53
|
| Rate for Payer: Beech Street Commercial |
$6.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.58
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.60
|
| Rate for Payer: Cigna of WY Commercial |
$6.66
|
| Rate for Payer: Entrust Commercial |
$6.46
|
| Rate for Payer: First Choice Health Commercial |
$6.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.94
|
| Rate for Payer: HealthUtah PPO |
$6.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.60
|
| Rate for Payer: Multiplan Medicare/VA |
$3.75
|
| Rate for Payer: One Health Plan of WY PPO |
$6.66
|
| Rate for Payer: PacificSource Commercial |
$6.12
|
| Rate for Payer: PHCS PPO |
$6.66
|
| Rate for Payer: Three Rivers PPO |
$5.10
|
| Rate for Payer: TriWest Veterans Administration |
$3.94
|
| Rate for Payer: United Healthcare Commercial |
$5.92
|
| Rate for Payer: United Healthcare Medicare |
$3.94
|
| Rate for Payer: WINHealth Partners Commercial |
$6.66
|
| Rate for Payer: Wise Provider Network Commercial |
$6.46
|
|
|
SUT ET PDS II 3-0 CT-1 Z338H
|
Facility
|
IP
|
$6.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.53
|
| Rate for Payer: Altius Commercial |
$6.53
|
| Rate for Payer: Beech Street Commercial |
$6.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.58
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.60
|
| Rate for Payer: Cigna of WY Commercial |
$6.66
|
| Rate for Payer: Entrust Commercial |
$6.46
|
| Rate for Payer: First Choice Health Commercial |
$6.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.49
|
| Rate for Payer: HealthUtah PPO |
$6.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.60
|
| Rate for Payer: Multiplan Medicare/VA |
$4.26
|
| Rate for Payer: One Health Plan of WY PPO |
$6.66
|
| Rate for Payer: PacificSource Commercial |
$6.12
|
| Rate for Payer: PHCS PPO |
$6.66
|
| Rate for Payer: Three Rivers PPO |
$5.10
|
| Rate for Payer: TriWest Veterans Administration |
$4.49
|
| Rate for Payer: United Healthcare Commercial |
$5.92
|
| Rate for Payer: United Healthcare Medicare |
$4.49
|
| Rate for Payer: WINHealth Partners Commercial |
$6.46
|
| Rate for Payer: Wise Provider Network Commercial |
$6.46
|
|
|
SUT ET PDS II 3-0 SH-1 Z311H
|
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 PDS II 3-0 SH-1 Z311H
|
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 PLAIN 4-0 SC-1 STRAIGHT
|
Facility
|
OP
|
$7.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.83
|
| Rate for Payer: Aetna of WY Medicare |
$5.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.67
|
| Rate for Payer: Altius Commercial |
$7.67
|
| Rate for Payer: Beech Street Commercial |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.56
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.75
|
| Rate for Payer: Cigna of WY Commercial |
$7.83
|
| Rate for Payer: Entrust Commercial |
$7.59
|
| Rate for Payer: First Choice Health Commercial |
$7.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.63
|
| Rate for Payer: HealthUtah PPO |
$7.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.75
|
| Rate for Payer: Multiplan Medicare/VA |
$4.40
|
| Rate for Payer: One Health Plan of WY PPO |
$7.83
|
| Rate for Payer: PacificSource Commercial |
$7.19
|
| Rate for Payer: PHCS PPO |
$7.83
|
| Rate for Payer: Three Rivers PPO |
$5.99
|
| Rate for Payer: TriWest Veterans Administration |
$4.63
|
| Rate for Payer: United Healthcare Commercial |
$6.95
|
| Rate for Payer: United Healthcare Medicare |
$4.63
|
| Rate for Payer: WINHealth Partners Commercial |
$7.83
|
| Rate for Payer: Wise Provider Network Commercial |
$7.59
|
|
|
SUT ET PLAIN 4-0 SC-1 STRAIGHT
|
Facility
|
IP
|
$7.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.67
|
| Rate for Payer: Altius Commercial |
$7.67
|
| Rate for Payer: Beech Street Commercial |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.56
|
| Rate for Payer: Cash Price |
$5.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.75
|
| Rate for Payer: Cigna of WY Commercial |
$7.83
|
| Rate for Payer: Entrust Commercial |
$7.59
|
| Rate for Payer: First Choice Health Commercial |
$7.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.27
|
| Rate for Payer: HealthUtah PPO |
$7.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.75
|
| Rate for Payer: Multiplan Medicare/VA |
$5.01
|
| Rate for Payer: One Health Plan of WY PPO |
$7.83
|
| Rate for Payer: PacificSource Commercial |
$7.19
|
| Rate for Payer: PHCS PPO |
$7.83
|
| Rate for Payer: Three Rivers PPO |
$5.99
|
| Rate for Payer: TriWest Veterans Administration |
$5.27
|
| Rate for Payer: United Healthcare Commercial |
$6.95
|
| Rate for Payer: United Healthcare Medicare |
$5.27
|
| Rate for Payer: WINHealth Partners Commercial |
$7.59
|
| Rate for Payer: Wise Provider Network Commercial |
$7.59
|
|
|
SUT ET PLAIN GUT 5-0 1915G
|
Facility
|
OP
|
$17.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.85
|
| Rate for Payer: Aetna of WY Medicare |
$11.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.50
|
| Rate for Payer: Altius Commercial |
$16.50
|
| Rate for Payer: Beech Street Commercial |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.11
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.67
|
| Rate for Payer: Cigna of WY Commercial |
$16.85
|
| Rate for Payer: Entrust Commercial |
$16.33
|
| Rate for Payer: First Choice Health Commercial |
$16.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.97
|
| Rate for Payer: HealthUtah PPO |
$17.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.67
|
| Rate for Payer: Multiplan Medicare/VA |
$9.47
|
| Rate for Payer: One Health Plan of WY PPO |
$16.85
|
| Rate for Payer: PacificSource Commercial |
$15.47
|
| Rate for Payer: PHCS PPO |
$16.85
|
| Rate for Payer: Three Rivers PPO |
$12.89
|
| Rate for Payer: TriWest Veterans Administration |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$9.97
|
| Rate for Payer: WINHealth Partners Commercial |
$16.85
|
| Rate for Payer: Wise Provider Network Commercial |
$16.33
|
|
|
SUT ET PLAIN GUT 5-0 1915G
|
Facility
|
IP
|
$17.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.50
|
| Rate for Payer: Altius Commercial |
$16.50
|
| Rate for Payer: Beech Street Commercial |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.11
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.67
|
| Rate for Payer: Cigna of WY Commercial |
$16.85
|
| Rate for Payer: Entrust Commercial |
$16.33
|
| Rate for Payer: First Choice Health Commercial |
$16.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.35
|
| Rate for Payer: HealthUtah PPO |
$17.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.67
|
| Rate for Payer: Multiplan Medicare/VA |
$10.78
|
| Rate for Payer: One Health Plan of WY PPO |
$16.85
|
| Rate for Payer: PacificSource Commercial |
$15.47
|
| Rate for Payer: PHCS PPO |
$16.85
|
| Rate for Payer: Three Rivers PPO |
$12.89
|
| Rate for Payer: TriWest Veterans Administration |
$11.35
|
| Rate for Payer: United Healthcare Commercial |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$11.35
|
| Rate for Payer: WINHealth Partners Commercial |
$16.33
|
| Rate for Payer: Wise Provider Network Commercial |
$16.33
|
|
|
SUT ET PROLENE 0 CT-1 8424H
|
Facility
|
IP
|
$6.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.68
|
| Rate for Payer: Altius Commercial |
$6.68
|
| Rate for Payer: Beech Street Commercial |
$6.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.71
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.75
|
| Rate for Payer: Cigna of WY Commercial |
$6.82
|
| Rate for Payer: Entrust Commercial |
$6.61
|
| Rate for Payer: First Choice Health Commercial |
$6.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.59
|
| Rate for Payer: HealthUtah PPO |
$6.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.75
|
| Rate for Payer: Multiplan Medicare/VA |
$4.36
|
| Rate for Payer: One Health Plan of WY PPO |
$6.82
|
| Rate for Payer: PacificSource Commercial |
$6.26
|
| Rate for Payer: PHCS PPO |
$6.82
|
| Rate for Payer: Three Rivers PPO |
$5.22
|
| Rate for Payer: TriWest Veterans Administration |
$4.59
|
| Rate for Payer: United Healthcare Commercial |
$6.06
|
| Rate for Payer: United Healthcare Medicare |
$4.59
|
| Rate for Payer: WINHealth Partners Commercial |
$6.61
|
| Rate for Payer: Wise Provider Network Commercial |
$6.61
|
|
|
SUT ET PROLENE 0 CT-1 8424H
|
Facility
|
OP
|
$6.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.82
|
| Rate for Payer: Aetna of WY Medicare |
$4.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.68
|
| Rate for Payer: Altius Commercial |
$6.68
|
| Rate for Payer: Beech Street Commercial |
$6.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.71
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.75
|
| Rate for Payer: Cigna of WY Commercial |
$6.82
|
| Rate for Payer: Entrust Commercial |
$6.61
|
| Rate for Payer: First Choice Health Commercial |
$6.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.04
|
| Rate for Payer: HealthUtah PPO |
$6.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.75
|
| Rate for Payer: Multiplan Medicare/VA |
$3.83
|
| Rate for Payer: One Health Plan of WY PPO |
$6.82
|
| Rate for Payer: PacificSource Commercial |
$6.26
|
| Rate for Payer: PHCS PPO |
$6.82
|
| Rate for Payer: Three Rivers PPO |
$5.22
|
| Rate for Payer: TriWest Veterans Administration |
$4.04
|
| Rate for Payer: United Healthcare Commercial |
$6.06
|
| Rate for Payer: United Healthcare Medicare |
$4.04
|
| Rate for Payer: WINHealth Partners Commercial |
$6.82
|
| Rate for Payer: Wise Provider Network Commercial |
$6.61
|
|
|
SUT ET PROLENE 1 CT-1 8425H
|
Facility
|
OP
|
$7.07
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.93
|
| Rate for Payer: Aetna of WY Medicare |
$4.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.79
|
| Rate for Payer: Altius Commercial |
$6.79
|
| Rate for Payer: Beech Street Commercial |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.86
|
| Rate for Payer: Cigna of WY Commercial |
$6.93
|
| Rate for Payer: Entrust Commercial |
$6.72
|
| Rate for Payer: First Choice Health Commercial |
$6.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.10
|
| Rate for Payer: HealthUtah PPO |
$7.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.86
|
| Rate for Payer: Multiplan Medicare/VA |
$3.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6.93
|
| Rate for Payer: PacificSource Commercial |
$6.36
|
| Rate for Payer: PHCS PPO |
$6.93
|
| Rate for Payer: Three Rivers PPO |
$5.30
|
| Rate for Payer: TriWest Veterans Administration |
$4.10
|
| Rate for Payer: United Healthcare Commercial |
$6.15
|
| Rate for Payer: United Healthcare Medicare |
$4.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6.93
|
| Rate for Payer: Wise Provider Network Commercial |
$6.72
|
|
|
SUT ET PROLENE 1 CT-1 8425H
|
Facility
|
IP
|
$7.07
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.79
|
| Rate for Payer: Altius Commercial |
$6.79
|
| Rate for Payer: Beech Street Commercial |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.86
|
| Rate for Payer: Cigna of WY Commercial |
$6.93
|
| Rate for Payer: Entrust Commercial |
$6.72
|
| Rate for Payer: First Choice Health Commercial |
$6.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.67
|
| Rate for Payer: HealthUtah PPO |
$7.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.86
|
| Rate for Payer: Multiplan Medicare/VA |
$4.43
|
| Rate for Payer: One Health Plan of WY PPO |
$6.93
|
| Rate for Payer: PacificSource Commercial |
$6.36
|
| Rate for Payer: PHCS PPO |
$6.93
|
| Rate for Payer: Three Rivers PPO |
$5.30
|
| Rate for Payer: TriWest Veterans Administration |
$4.67
|
| Rate for Payer: United Healthcare Commercial |
$6.15
|
| Rate for Payer: United Healthcare Medicare |
$4.67
|
| Rate for Payer: WINHealth Partners Commercial |
$6.72
|
| Rate for Payer: Wise Provider Network Commercial |
$6.72
|
|
|
SUT ET PROLENE 2-0 FS 8685H
|
Facility
|
OP
|
$7.17
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.03
|
| Rate for Payer: Aetna of WY Medicare |
$4.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.88
|
| Rate for Payer: Altius Commercial |
$6.88
|
| Rate for Payer: Beech Street Commercial |
$7.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.89
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.95
|
| Rate for Payer: Cigna of WY Commercial |
$7.03
|
| Rate for Payer: Entrust Commercial |
$6.81
|
| Rate for Payer: First Choice Health Commercial |
$6.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.16
|
| Rate for Payer: HealthUtah PPO |
$7.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.95
|
| Rate for Payer: Multiplan Medicare/VA |
$3.95
|
| Rate for Payer: One Health Plan of WY PPO |
$7.03
|
| Rate for Payer: PacificSource Commercial |
$6.45
|
| Rate for Payer: PHCS PPO |
$7.03
|
| Rate for Payer: Three Rivers PPO |
$5.38
|
| Rate for Payer: TriWest Veterans Administration |
$4.16
|
| Rate for Payer: United Healthcare Commercial |
$6.24
|
| Rate for Payer: United Healthcare Medicare |
$4.16
|
| Rate for Payer: WINHealth Partners Commercial |
$7.03
|
| Rate for Payer: Wise Provider Network Commercial |
$6.81
|
|
|
SUT ET PROLENE 2-0 FS 8685H
|
Facility
|
IP
|
$7.17
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.88
|
| Rate for Payer: Altius Commercial |
$6.88
|
| Rate for Payer: Beech Street Commercial |
$7.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.89
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.95
|
| Rate for Payer: Cigna of WY Commercial |
$7.03
|
| Rate for Payer: Entrust Commercial |
$6.81
|
| Rate for Payer: First Choice Health Commercial |
$6.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.73
|
| Rate for Payer: HealthUtah PPO |
$7.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.95
|
| Rate for Payer: Multiplan Medicare/VA |
$4.50
|
| Rate for Payer: One Health Plan of WY PPO |
$7.03
|
| Rate for Payer: PacificSource Commercial |
$6.45
|
| Rate for Payer: PHCS PPO |
$7.03
|
| Rate for Payer: Three Rivers PPO |
$5.38
|
| Rate for Payer: TriWest Veterans Administration |
$4.73
|
| Rate for Payer: United Healthcare Commercial |
$6.24
|
| Rate for Payer: United Healthcare Medicare |
$4.73
|
| Rate for Payer: WINHealth Partners Commercial |
$6.81
|
| Rate for Payer: Wise Provider Network Commercial |
$6.81
|
|
|
SUT ET PROLENE 2-0 KS STRAIGHT
|
Facility
|
IP
|
$7.44
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.14
|
| Rate for Payer: Altius Commercial |
$7.14
|
| Rate for Payer: Beech Street Commercial |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.11
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.22
|
| Rate for Payer: Cigna of WY Commercial |
$7.29
|
| Rate for Payer: Entrust Commercial |
$7.07
|
| Rate for Payer: First Choice Health Commercial |
$7.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.91
|
| Rate for Payer: HealthUtah PPO |
$7.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.22
|
| Rate for Payer: Multiplan Medicare/VA |
$4.66
|
| Rate for Payer: One Health Plan of WY PPO |
$7.29
|
| Rate for Payer: PacificSource Commercial |
$6.70
|
| Rate for Payer: PHCS PPO |
$7.29
|
| Rate for Payer: Three Rivers PPO |
$5.58
|
| Rate for Payer: TriWest Veterans Administration |
$4.91
|
| Rate for Payer: United Healthcare Commercial |
$6.47
|
| Rate for Payer: United Healthcare Medicare |
$4.91
|
| Rate for Payer: WINHealth Partners Commercial |
$7.07
|
| Rate for Payer: Wise Provider Network Commercial |
$7.07
|
|
|
SUT ET PROLENE 2-0 KS STRAIGHT
|
Facility
|
OP
|
$7.44
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.29
|
| Rate for Payer: Aetna of WY Medicare |
$4.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.14
|
| Rate for Payer: Altius Commercial |
$7.14
|
| Rate for Payer: Beech Street Commercial |
$7.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.11
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.22
|
| Rate for Payer: Cigna of WY Commercial |
$7.29
|
| Rate for Payer: Entrust Commercial |
$7.07
|
| Rate for Payer: First Choice Health Commercial |
$7.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.32
|
| Rate for Payer: HealthUtah PPO |
$7.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.22
|
| Rate for Payer: Multiplan Medicare/VA |
$4.10
|
| Rate for Payer: One Health Plan of WY PPO |
$7.29
|
| Rate for Payer: PacificSource Commercial |
$6.70
|
| Rate for Payer: PHCS PPO |
$7.29
|
| Rate for Payer: Three Rivers PPO |
$5.58
|
| Rate for Payer: TriWest Veterans Administration |
$4.32
|
| Rate for Payer: United Healthcare Commercial |
$6.47
|
| Rate for Payer: United Healthcare Medicare |
$4.32
|
| Rate for Payer: WINHealth Partners Commercial |
$7.29
|
| Rate for Payer: Wise Provider Network Commercial |
$7.07
|
|
|
SUT ET PROLENE 2-0 SH 8833H
|
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 PROLENE 2-0 SH 8833H
|
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 PROLENE 3-0 PS-2 8687H
|
Facility
|
IP
|
$12.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.25
|
| Rate for Payer: Altius Commercial |
$12.25
|
| Rate for Payer: Beech Street Commercial |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.38
|
| Rate for Payer: Cigna of WY Commercial |
$12.50
|
| Rate for Payer: Entrust Commercial |
$12.12
|
| Rate for Payer: First Choice Health Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.42
|
| Rate for Payer: HealthUtah PPO |
$12.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.38
|
| Rate for Payer: Multiplan Medicare/VA |
$8.00
|
| Rate for Payer: One Health Plan of WY PPO |
$12.50
|
| Rate for Payer: PacificSource Commercial |
$11.48
|
| Rate for Payer: PHCS PPO |
$12.50
|
| Rate for Payer: Three Rivers PPO |
$9.57
|
| Rate for Payer: TriWest Veterans Administration |
$8.42
|
| Rate for Payer: United Healthcare Commercial |
$11.10
|
| Rate for Payer: United Healthcare Medicare |
$8.42
|
| Rate for Payer: WINHealth Partners Commercial |
$12.12
|
| Rate for Payer: Wise Provider Network Commercial |
$12.12
|
|
|
SUT ET PROLENE 3-0 PS-2 8687H
|
Facility
|
OP
|
$12.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
| Rate for Payer: Aetna of WY Medicare |
$8.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.25
|
| Rate for Payer: Altius Commercial |
$12.25
|
| Rate for Payer: Beech Street Commercial |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.38
|
| Rate for Payer: Cigna of WY Commercial |
$12.50
|
| Rate for Payer: Entrust Commercial |
$12.12
|
| Rate for Payer: First Choice Health Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.40
|
| Rate for Payer: HealthUtah PPO |
$12.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.38
|
| Rate for Payer: Multiplan Medicare/VA |
$7.03
|
| Rate for Payer: One Health Plan of WY PPO |
$12.50
|
| Rate for Payer: PacificSource Commercial |
$11.48
|
| Rate for Payer: PHCS PPO |
$12.50
|
| Rate for Payer: Three Rivers PPO |
$9.57
|
| Rate for Payer: TriWest Veterans Administration |
$7.40
|
| Rate for Payer: United Healthcare Commercial |
$11.10
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WINHealth Partners Commercial |
$12.50
|
| Rate for Payer: Wise Provider Network Commercial |
$12.12
|
|
|
SUT ET PROLENE 3-0 SH 8832H
|
Facility
|
OP
|
$7.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.69
|
| Rate for Payer: Aetna of WY Medicare |
$5.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.54
|
| Rate for Payer: Altius Commercial |
$7.54
|
| Rate for Payer: Beech Street Commercial |
$7.69
|
| 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 |
$7.61
|
| Rate for Payer: Cigna of WY Commercial |
$7.69
|
| Rate for Payer: Entrust Commercial |
$7.46
|
| Rate for Payer: First Choice Health Commercial |
$7.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.55
|
| Rate for Payer: HealthUtah PPO |
$7.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.61
|
| Rate for Payer: Multiplan Medicare/VA |
$4.33
|
| Rate for Payer: One Health Plan of WY PPO |
$7.69
|
| Rate for Payer: PacificSource Commercial |
$7.06
|
| Rate for Payer: PHCS PPO |
$7.69
|
| Rate for Payer: Three Rivers PPO |
$5.89
|
| Rate for Payer: TriWest Veterans Administration |
$4.55
|
| Rate for Payer: United Healthcare Commercial |
$6.83
|
| Rate for Payer: United Healthcare Medicare |
$4.55
|
| Rate for Payer: WINHealth Partners Commercial |
$7.69
|
| Rate for Payer: Wise Provider Network Commercial |
$7.46
|
|
