|
SUT ET PROLENE 3-0 SH 8832H
|
Facility
|
IP
|
$7.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.69
|
| 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 |
$5.18
|
| Rate for Payer: HealthUtah PPO |
$7.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.61
|
| Rate for Payer: Multiplan Medicare/VA |
$4.92
|
| 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 |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.83
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WINHealth Partners Commercial |
$7.46
|
| Rate for Payer: Wise Provider Network Commercial |
$7.46
|
|
|
SUT ET PROLENE 4-0 PC-3 8634G
|
Facility
|
OP
|
$14.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.53
|
| Rate for Payer: Aetna of WY Medicare |
$9.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.24
|
| Rate for Payer: Altius Commercial |
$14.24
|
| Rate for Payer: Beech Street Commercial |
$14.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.18
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.39
|
| Rate for Payer: Cigna of WY Commercial |
$14.53
|
| Rate for Payer: Entrust Commercial |
$14.09
|
| Rate for Payer: First Choice Health Commercial |
$14.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.60
|
| Rate for Payer: HealthUtah PPO |
$14.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.39
|
| Rate for Payer: Multiplan Medicare/VA |
$8.17
|
| Rate for Payer: One Health Plan of WY PPO |
$14.53
|
| Rate for Payer: PacificSource Commercial |
$13.35
|
| Rate for Payer: PHCS PPO |
$14.53
|
| Rate for Payer: Three Rivers PPO |
$11.12
|
| Rate for Payer: TriWest Veterans Administration |
$8.60
|
| Rate for Payer: United Healthcare Commercial |
$12.90
|
| Rate for Payer: United Healthcare Medicare |
$8.60
|
| Rate for Payer: WINHealth Partners Commercial |
$14.53
|
| Rate for Payer: Wise Provider Network Commercial |
$14.09
|
|
|
SUT ET PROLENE 4-0 PC-3 8634G
|
Facility
|
IP
|
$14.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.24
|
| Rate for Payer: Altius Commercial |
$14.24
|
| Rate for Payer: Beech Street Commercial |
$14.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.18
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.39
|
| Rate for Payer: Cigna of WY Commercial |
$14.53
|
| Rate for Payer: Entrust Commercial |
$14.09
|
| Rate for Payer: First Choice Health Commercial |
$14.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.79
|
| Rate for Payer: HealthUtah PPO |
$14.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.39
|
| Rate for Payer: Multiplan Medicare/VA |
$9.30
|
| Rate for Payer: One Health Plan of WY PPO |
$14.53
|
| Rate for Payer: PacificSource Commercial |
$13.35
|
| Rate for Payer: PHCS PPO |
$14.53
|
| Rate for Payer: Three Rivers PPO |
$11.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.79
|
| Rate for Payer: United Healthcare Commercial |
$12.90
|
| Rate for Payer: United Healthcare Medicare |
$9.79
|
| Rate for Payer: WINHealth Partners Commercial |
$14.09
|
| Rate for Payer: Wise Provider Network Commercial |
$14.09
|
|
|
SUT ET PROLENE 5-0 P-3 8698G
|
Facility
|
OP
|
$13.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.29
|
| Rate for Payer: Aetna of WY Medicare |
$8.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.02
|
| Rate for Payer: Altius Commercial |
$13.02
|
| Rate for Payer: Beech Street Commercial |
$13.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.13
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.15
|
| Rate for Payer: Cigna of WY Commercial |
$13.29
|
| Rate for Payer: Entrust Commercial |
$12.88
|
| Rate for Payer: First Choice Health Commercial |
$12.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.86
|
| Rate for Payer: HealthUtah PPO |
$13.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.15
|
| Rate for Payer: Multiplan Medicare/VA |
$7.47
|
| Rate for Payer: One Health Plan of WY PPO |
$13.29
|
| Rate for Payer: PacificSource Commercial |
$12.20
|
| Rate for Payer: PHCS PPO |
$13.29
|
| Rate for Payer: Three Rivers PPO |
$10.17
|
| Rate for Payer: TriWest Veterans Administration |
$7.86
|
| Rate for Payer: United Healthcare Commercial |
$11.80
|
| Rate for Payer: United Healthcare Medicare |
$7.86
|
| Rate for Payer: WINHealth Partners Commercial |
$13.29
|
| Rate for Payer: Wise Provider Network Commercial |
$12.88
|
|
|
SUT ET PROLENE 5-0 P-3 8698G
|
Facility
|
IP
|
$13.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$13.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.02
|
| Rate for Payer: Altius Commercial |
$13.02
|
| Rate for Payer: Beech Street Commercial |
$13.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.13
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.15
|
| Rate for Payer: Cigna of WY Commercial |
$13.29
|
| Rate for Payer: Entrust Commercial |
$12.88
|
| Rate for Payer: First Choice Health Commercial |
$12.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.95
|
| Rate for Payer: HealthUtah PPO |
$13.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.15
|
| Rate for Payer: Multiplan Medicare/VA |
$8.50
|
| Rate for Payer: One Health Plan of WY PPO |
$13.29
|
| Rate for Payer: PacificSource Commercial |
$12.20
|
| Rate for Payer: PHCS PPO |
$13.29
|
| Rate for Payer: Three Rivers PPO |
$10.17
|
| Rate for Payer: TriWest Veterans Administration |
$8.95
|
| Rate for Payer: United Healthcare Commercial |
$11.80
|
| Rate for Payer: United Healthcare Medicare |
$8.95
|
| Rate for Payer: WINHealth Partners Commercial |
$12.88
|
| Rate for Payer: Wise Provider Network Commercial |
$12.88
|
|
|
SUT ET PROLENE 5-0 PS-3 8681G
|
Facility
|
OP
|
$13.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.35
|
| Rate for Payer: Aetna of WY Medicare |
$8.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.08
|
| Rate for Payer: Altius Commercial |
$13.08
|
| Rate for Payer: Beech Street Commercial |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.18
|
| Rate for Payer: Cash Price |
$9.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.21
|
| Rate for Payer: Cigna of WY Commercial |
$13.35
|
| Rate for Payer: Entrust Commercial |
$12.94
|
| Rate for Payer: First Choice Health Commercial |
$12.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.90
|
| Rate for Payer: HealthUtah PPO |
$13.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.21
|
| Rate for Payer: Multiplan Medicare/VA |
$7.50
|
| Rate for Payer: One Health Plan of WY PPO |
$13.35
|
| Rate for Payer: PacificSource Commercial |
$12.26
|
| Rate for Payer: PHCS PPO |
$13.35
|
| Rate for Payer: Three Rivers PPO |
$10.22
|
| Rate for Payer: TriWest Veterans Administration |
$7.90
|
| Rate for Payer: United Healthcare Commercial |
$11.85
|
| Rate for Payer: United Healthcare Medicare |
$7.90
|
| Rate for Payer: WINHealth Partners Commercial |
$13.35
|
| Rate for Payer: Wise Provider Network Commercial |
$12.94
|
|
|
SUT ET PROLENE 5-0 PS-3 8681G
|
Facility
|
IP
|
$13.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.08
|
| Rate for Payer: Altius Commercial |
$13.08
|
| Rate for Payer: Beech Street Commercial |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.18
|
| Rate for Payer: Cash Price |
$9.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.21
|
| Rate for Payer: Cigna of WY Commercial |
$13.35
|
| Rate for Payer: Entrust Commercial |
$12.94
|
| Rate for Payer: First Choice Health Commercial |
$12.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.99
|
| Rate for Payer: HealthUtah PPO |
$13.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.21
|
| Rate for Payer: Multiplan Medicare/VA |
$8.54
|
| Rate for Payer: One Health Plan of WY PPO |
$13.35
|
| Rate for Payer: PacificSource Commercial |
$12.26
|
| Rate for Payer: PHCS PPO |
$13.35
|
| Rate for Payer: Three Rivers PPO |
$10.22
|
| Rate for Payer: TriWest Veterans Administration |
$8.99
|
| Rate for Payer: United Healthcare Commercial |
$11.85
|
| Rate for Payer: United Healthcare Medicare |
$8.99
|
| Rate for Payer: WINHealth Partners Commercial |
$12.94
|
| Rate for Payer: Wise Provider Network Commercial |
$12.94
|
|
|
SUT ET PROLENE 5-0 RB-1 8870H
|
Facility
|
OP
|
$7.93
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.77
|
| Rate for Payer: Aetna of WY Medicare |
$5.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.61
|
| Rate for Payer: Altius Commercial |
$7.61
|
| Rate for Payer: Beech Street Commercial |
$7.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.69
|
| Rate for Payer: Cigna of WY Commercial |
$7.77
|
| Rate for Payer: Entrust Commercial |
$7.53
|
| Rate for Payer: First Choice Health Commercial |
$7.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.60
|
| Rate for Payer: HealthUtah PPO |
$7.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.69
|
| Rate for Payer: Multiplan Medicare/VA |
$4.37
|
| Rate for Payer: One Health Plan of WY PPO |
$7.77
|
| Rate for Payer: PacificSource Commercial |
$7.14
|
| Rate for Payer: PHCS PPO |
$7.77
|
| Rate for Payer: Three Rivers PPO |
$5.95
|
| Rate for Payer: TriWest Veterans Administration |
$4.60
|
| Rate for Payer: United Healthcare Commercial |
$6.90
|
| Rate for Payer: United Healthcare Medicare |
$4.60
|
| Rate for Payer: WINHealth Partners Commercial |
$7.77
|
| Rate for Payer: Wise Provider Network Commercial |
$7.53
|
|
|
SUT ET PROLENE 5-0 RB-1 8870H
|
Facility
|
IP
|
$7.93
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.61
|
| Rate for Payer: Altius Commercial |
$7.61
|
| Rate for Payer: Beech Street Commercial |
$7.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.69
|
| Rate for Payer: Cigna of WY Commercial |
$7.77
|
| Rate for Payer: Entrust Commercial |
$7.53
|
| Rate for Payer: First Choice Health Commercial |
$7.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.23
|
| Rate for Payer: HealthUtah PPO |
$7.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.69
|
| Rate for Payer: Multiplan Medicare/VA |
$4.97
|
| Rate for Payer: One Health Plan of WY PPO |
$7.77
|
| Rate for Payer: PacificSource Commercial |
$7.14
|
| Rate for Payer: PHCS PPO |
$7.77
|
| Rate for Payer: Three Rivers PPO |
$5.95
|
| Rate for Payer: TriWest Veterans Administration |
$5.23
|
| Rate for Payer: United Healthcare Commercial |
$6.90
|
| Rate for Payer: United Healthcare Medicare |
$5.23
|
| Rate for Payer: WINHealth Partners Commercial |
$7.53
|
| Rate for Payer: Wise Provider Network Commercial |
$7.53
|
|
|
SUT ET PROLENE 6-0 P-3 8695G
|
Facility
|
OP
|
$14.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.84
|
| Rate for Payer: Aetna of WY Medicare |
$9.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.56
|
| Rate for Payer: Altius Commercial |
$13.56
|
| Rate for Payer: Beech Street Commercial |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.59
|
| Rate for Payer: Cash Price |
$9.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.70
|
| Rate for Payer: Cigna of WY Commercial |
$13.84
|
| Rate for Payer: Entrust Commercial |
$13.41
|
| Rate for Payer: First Choice Health Commercial |
$13.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.19
|
| Rate for Payer: HealthUtah PPO |
$14.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.70
|
| Rate for Payer: Multiplan Medicare/VA |
$7.78
|
| Rate for Payer: One Health Plan of WY PPO |
$13.84
|
| Rate for Payer: PacificSource Commercial |
$12.71
|
| Rate for Payer: PHCS PPO |
$13.84
|
| Rate for Payer: Three Rivers PPO |
$10.59
|
| Rate for Payer: TriWest Veterans Administration |
$8.19
|
| Rate for Payer: United Healthcare Commercial |
$12.28
|
| Rate for Payer: United Healthcare Medicare |
$8.19
|
| Rate for Payer: WINHealth Partners Commercial |
$13.84
|
| Rate for Payer: Wise Provider Network Commercial |
$13.41
|
|
|
SUT ET PROLENE 6-0 P-3 8695G
|
Facility
|
IP
|
$14.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$14.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.56
|
| Rate for Payer: Altius Commercial |
$13.56
|
| Rate for Payer: Beech Street Commercial |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.59
|
| Rate for Payer: Cash Price |
$9.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.70
|
| Rate for Payer: Cigna of WY Commercial |
$13.84
|
| Rate for Payer: Entrust Commercial |
$13.41
|
| Rate for Payer: First Choice Health Commercial |
$13.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.32
|
| Rate for Payer: HealthUtah PPO |
$14.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.70
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: One Health Plan of WY PPO |
$13.84
|
| Rate for Payer: PacificSource Commercial |
$12.71
|
| Rate for Payer: PHCS PPO |
$13.84
|
| Rate for Payer: Three Rivers PPO |
$10.59
|
| Rate for Payer: TriWest Veterans Administration |
$9.32
|
| Rate for Payer: United Healthcare Commercial |
$12.28
|
| Rate for Payer: United Healthcare Medicare |
$9.32
|
| Rate for Payer: WINHealth Partners Commercial |
$13.41
|
| Rate for Payer: Wise Provider Network Commercial |
$13.41
|
|
|
SUT ET PROLENE 6-0 PS3 8680G
|
Facility
|
OP
|
$13.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.43
|
| Rate for Payer: Altius Commercial |
$13.43
|
| Rate for Payer: Beech Street Commercial |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.49
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.57
|
| Rate for Payer: Cigna of WY Commercial |
$13.71
|
| Rate for Payer: Entrust Commercial |
$13.29
|
| Rate for Payer: First Choice Health Commercial |
$13.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.11
|
| Rate for Payer: HealthUtah PPO |
$13.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.57
|
| Rate for Payer: Multiplan Medicare/VA |
$7.71
|
| Rate for Payer: One Health Plan of WY PPO |
$13.71
|
| Rate for Payer: PacificSource Commercial |
$12.59
|
| Rate for Payer: PHCS PPO |
$13.71
|
| Rate for Payer: Three Rivers PPO |
$10.49
|
| Rate for Payer: TriWest Veterans Administration |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$12.17
|
| Rate for Payer: United Healthcare Medicare |
$8.11
|
| Rate for Payer: WINHealth Partners Commercial |
$13.71
|
| Rate for Payer: Wise Provider Network Commercial |
$13.29
|
|
|
SUT ET PROLENE 6-0 PS3 8680G
|
Facility
|
IP
|
$13.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.43
|
| Rate for Payer: Altius Commercial |
$13.43
|
| Rate for Payer: Beech Street Commercial |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.49
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.57
|
| Rate for Payer: Cigna of WY Commercial |
$13.71
|
| Rate for Payer: Entrust Commercial |
$13.29
|
| Rate for Payer: First Choice Health Commercial |
$13.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.23
|
| Rate for Payer: HealthUtah PPO |
$13.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.77
|
| Rate for Payer: One Health Plan of WY PPO |
$13.71
|
| Rate for Payer: PacificSource Commercial |
$12.59
|
| Rate for Payer: PHCS PPO |
$13.71
|
| Rate for Payer: Three Rivers PPO |
$10.49
|
| Rate for Payer: TriWest Veterans Administration |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$12.17
|
| Rate for Payer: United Healthcare Medicare |
$9.23
|
| Rate for Payer: WINHealth Partners Commercial |
$13.29
|
| Rate for Payer: Wise Provider Network Commercial |
$13.29
|
|
|
SUT ET PROLENE 7-0, P-6
|
Facility
|
IP
|
$14.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$14.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.17
|
| Rate for Payer: Altius Commercial |
$14.17
|
| Rate for Payer: Beech Street Commercial |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.12
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.32
|
| Rate for Payer: Cigna of WY Commercial |
$14.46
|
| Rate for Payer: Entrust Commercial |
$14.02
|
| Rate for Payer: First Choice Health Commercial |
$14.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.74
|
| Rate for Payer: HealthUtah PPO |
$14.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.32
|
| Rate for Payer: Multiplan Medicare/VA |
$9.25
|
| Rate for Payer: One Health Plan of WY PPO |
$14.46
|
| Rate for Payer: PacificSource Commercial |
$13.28
|
| Rate for Payer: PHCS PPO |
$14.46
|
| Rate for Payer: Three Rivers PPO |
$11.07
|
| Rate for Payer: TriWest Veterans Administration |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$12.84
|
| Rate for Payer: United Healthcare Medicare |
$9.74
|
| Rate for Payer: WINHealth Partners Commercial |
$14.02
|
| Rate for Payer: Wise Provider Network Commercial |
$14.02
|
|
|
SUT ET PROLENE 7-0, P-6
|
Facility
|
OP
|
$14.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$14.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.46
|
| Rate for Payer: Aetna of WY Medicare |
$9.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.17
|
| Rate for Payer: Altius Commercial |
$14.17
|
| Rate for Payer: Beech Street Commercial |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.12
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.32
|
| Rate for Payer: Cigna of WY Commercial |
$14.46
|
| Rate for Payer: Entrust Commercial |
$14.02
|
| Rate for Payer: First Choice Health Commercial |
$14.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.56
|
| Rate for Payer: HealthUtah PPO |
$14.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.32
|
| Rate for Payer: Multiplan Medicare/VA |
$8.13
|
| Rate for Payer: One Health Plan of WY PPO |
$14.46
|
| Rate for Payer: PacificSource Commercial |
$13.28
|
| Rate for Payer: PHCS PPO |
$14.46
|
| Rate for Payer: Three Rivers PPO |
$11.07
|
| Rate for Payer: TriWest Veterans Administration |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$12.84
|
| Rate for Payer: United Healthcare Medicare |
$8.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.46
|
| Rate for Payer: Wise Provider Network Commercial |
$14.02
|
|
|
SUT ET PROLENE O MO-6 8418H
|
Facility
|
IP
|
$8.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.51
|
| Rate for Payer: Altius Commercial |
$8.51
|
| Rate for Payer: Beech Street Commercial |
$8.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.27
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.59
|
| Rate for Payer: Cigna of WY Commercial |
$8.68
|
| Rate for Payer: Entrust Commercial |
$8.42
|
| Rate for Payer: First Choice Health Commercial |
$8.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.85
|
| Rate for Payer: HealthUtah PPO |
$8.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.59
|
| Rate for Payer: Multiplan Medicare/VA |
$5.56
|
| Rate for Payer: One Health Plan of WY PPO |
$8.68
|
| Rate for Payer: PacificSource Commercial |
$7.97
|
| Rate for Payer: PHCS PPO |
$8.68
|
| Rate for Payer: Three Rivers PPO |
$6.64
|
| Rate for Payer: TriWest Veterans Administration |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$7.71
|
| Rate for Payer: United Healthcare Medicare |
$5.85
|
| Rate for Payer: WINHealth Partners Commercial |
$8.42
|
| Rate for Payer: Wise Provider Network Commercial |
$8.42
|
|
|
SUT ET PROLENE O MO-6 8418H
|
Facility
|
OP
|
$8.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.68
|
| Rate for Payer: Aetna of WY Medicare |
$5.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.51
|
| Rate for Payer: Altius Commercial |
$8.51
|
| Rate for Payer: Beech Street Commercial |
$8.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.27
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.59
|
| Rate for Payer: Cigna of WY Commercial |
$8.68
|
| Rate for Payer: Entrust Commercial |
$8.42
|
| Rate for Payer: First Choice Health Commercial |
$8.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.14
|
| Rate for Payer: HealthUtah PPO |
$8.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.59
|
| Rate for Payer: Multiplan Medicare/VA |
$4.88
|
| Rate for Payer: One Health Plan of WY PPO |
$8.68
|
| Rate for Payer: PacificSource Commercial |
$7.97
|
| Rate for Payer: PHCS PPO |
$8.68
|
| Rate for Payer: Three Rivers PPO |
$6.64
|
| Rate for Payer: TriWest Veterans Administration |
$5.14
|
| Rate for Payer: United Healthcare Commercial |
$7.71
|
| Rate for Payer: United Healthcare Medicare |
$5.14
|
| Rate for Payer: WINHealth Partners Commercial |
$8.68
|
| Rate for Payer: Wise Provider Network Commercial |
$8.42
|
|
|
SUT ET SILK 0 TIE A186H
|
Facility
|
IP
|
$1.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.88
|
| Rate for Payer: Altius Commercial |
$1.88
|
| Rate for Payer: Beech Street Commercial |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.90
|
| Rate for Payer: Cigna of WY Commercial |
$1.92
|
| Rate for Payer: Entrust Commercial |
$1.86
|
| Rate for Payer: First Choice Health Commercial |
$1.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.29
|
| Rate for Payer: HealthUtah PPO |
$1.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1.92
|
| Rate for Payer: PacificSource Commercial |
$1.76
|
| Rate for Payer: PHCS PPO |
$1.92
|
| Rate for Payer: Three Rivers PPO |
$1.47
|
| Rate for Payer: TriWest Veterans Administration |
$1.29
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
| Rate for Payer: United Healthcare Medicare |
$1.29
|
| Rate for Payer: WINHealth Partners Commercial |
$1.86
|
| Rate for Payer: Wise Provider Network Commercial |
$1.86
|
|
|
SUT ET SILK 0 TIE A186H
|
Facility
|
OP
|
$1.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.92
|
| Rate for Payer: Aetna of WY Medicare |
$1.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.88
|
| Rate for Payer: Altius Commercial |
$1.88
|
| Rate for Payer: Beech Street Commercial |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.90
|
| Rate for Payer: Cigna of WY Commercial |
$1.92
|
| Rate for Payer: Entrust Commercial |
$1.86
|
| Rate for Payer: First Choice Health Commercial |
$1.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.14
|
| Rate for Payer: HealthUtah PPO |
$1.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1.92
|
| Rate for Payer: PacificSource Commercial |
$1.76
|
| Rate for Payer: PHCS PPO |
$1.92
|
| Rate for Payer: Three Rivers PPO |
$1.47
|
| Rate for Payer: TriWest Veterans Administration |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1.92
|
| Rate for Payer: Wise Provider Network Commercial |
$1.86
|
|
|
SUT ET SILK 2-0 FS 685G
|
Facility
|
OP
|
$4.09
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.01
|
| Rate for Payer: Aetna of WY Medicare |
$2.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.93
|
| Rate for Payer: Altius Commercial |
$3.93
|
| Rate for Payer: Beech Street Commercial |
$4.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.97
|
| Rate for Payer: Cigna of WY Commercial |
$4.01
|
| Rate for Payer: Entrust Commercial |
$3.89
|
| Rate for Payer: First Choice Health Commercial |
$3.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.37
|
| Rate for Payer: HealthUtah PPO |
$4.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.97
|
| Rate for Payer: Multiplan Medicare/VA |
$2.25
|
| Rate for Payer: One Health Plan of WY PPO |
$4.01
|
| Rate for Payer: PacificSource Commercial |
$3.68
|
| Rate for Payer: PHCS PPO |
$4.01
|
| Rate for Payer: Three Rivers PPO |
$3.07
|
| Rate for Payer: TriWest Veterans Administration |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$3.56
|
| Rate for Payer: United Healthcare Medicare |
$2.37
|
| Rate for Payer: WINHealth Partners Commercial |
$4.01
|
| Rate for Payer: Wise Provider Network Commercial |
$3.89
|
|
|
SUT ET SILK 2-0 FS 685G
|
Facility
|
IP
|
$4.09
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.93
|
| Rate for Payer: Altius Commercial |
$3.93
|
| Rate for Payer: Beech Street Commercial |
$4.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.97
|
| Rate for Payer: Cigna of WY Commercial |
$4.01
|
| Rate for Payer: Entrust Commercial |
$3.89
|
| Rate for Payer: First Choice Health Commercial |
$3.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.70
|
| Rate for Payer: HealthUtah PPO |
$4.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.97
|
| Rate for Payer: Multiplan Medicare/VA |
$2.56
|
| Rate for Payer: One Health Plan of WY PPO |
$4.01
|
| Rate for Payer: PacificSource Commercial |
$3.68
|
| Rate for Payer: PHCS PPO |
$4.01
|
| Rate for Payer: Three Rivers PPO |
$3.07
|
| Rate for Payer: TriWest Veterans Administration |
$2.70
|
| Rate for Payer: United Healthcare Commercial |
$3.56
|
| Rate for Payer: United Healthcare Medicare |
$2.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3.89
|
| Rate for Payer: Wise Provider Network Commercial |
$3.89
|
|
|
SUT ET SILK 2-0 SH K833H
|
Facility
|
OP
|
$3.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.18
|
| Rate for Payer: Aetna of WY Medicare |
$2.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.12
|
| Rate for Payer: Altius Commercial |
$3.12
|
| Rate for Payer: Beech Street Commercial |
$3.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.15
|
| Rate for Payer: Cigna of WY Commercial |
$3.18
|
| Rate for Payer: Entrust Commercial |
$3.09
|
| Rate for Payer: First Choice Health Commercial |
$3.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.88
|
| Rate for Payer: HealthUtah PPO |
$3.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1.79
|
| Rate for Payer: One Health Plan of WY PPO |
$3.18
|
| Rate for Payer: PacificSource Commercial |
$2.92
|
| Rate for Payer: PHCS PPO |
$3.18
|
| Rate for Payer: Three Rivers PPO |
$2.44
|
| Rate for Payer: TriWest Veterans Administration |
$1.88
|
| Rate for Payer: United Healthcare Commercial |
$2.83
|
| Rate for Payer: United Healthcare Medicare |
$1.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3.18
|
| Rate for Payer: Wise Provider Network Commercial |
$3.09
|
|
|
SUT ET SILK 2-0 SH K833H
|
Facility
|
IP
|
$3.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.12
|
| Rate for Payer: Altius Commercial |
$3.12
|
| Rate for Payer: Beech Street Commercial |
$3.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.15
|
| Rate for Payer: Cigna of WY Commercial |
$3.18
|
| Rate for Payer: Entrust Commercial |
$3.09
|
| Rate for Payer: First Choice Health Commercial |
$3.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.14
|
| Rate for Payer: HealthUtah PPO |
$3.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.15
|
| Rate for Payer: Multiplan Medicare/VA |
$2.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3.18
|
| Rate for Payer: PacificSource Commercial |
$2.92
|
| Rate for Payer: PHCS PPO |
$3.18
|
| Rate for Payer: Three Rivers PPO |
$2.44
|
| Rate for Payer: TriWest Veterans Administration |
$2.14
|
| Rate for Payer: United Healthcare Commercial |
$2.83
|
| Rate for Payer: United Healthcare Medicare |
$2.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3.09
|
| Rate for Payer: Wise Provider Network Commercial |
$3.09
|
|
|
SUT ET SILK 2-0 TIE SA5H
|
Facility
|
OP
|
$3.26
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.19
|
| Rate for Payer: Aetna of WY Medicare |
$2.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.13
|
| Rate for Payer: Altius Commercial |
$3.13
|
| Rate for Payer: Beech Street Commercial |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.16
|
| Rate for Payer: Cigna of WY Commercial |
$3.19
|
| Rate for Payer: Entrust Commercial |
$3.10
|
| Rate for Payer: First Choice Health Commercial |
$3.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.89
|
| Rate for Payer: HealthUtah PPO |
$3.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.16
|
| Rate for Payer: Multiplan Medicare/VA |
$1.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3.19
|
| Rate for Payer: PacificSource Commercial |
$2.93
|
| Rate for Payer: PHCS PPO |
$3.19
|
| Rate for Payer: Three Rivers PPO |
$2.44
|
| Rate for Payer: TriWest Veterans Administration |
$1.89
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Medicare |
$1.89
|
| Rate for Payer: WINHealth Partners Commercial |
$3.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3.10
|
|
|
SUT ET SILK 2-0 TIE SA5H
|
Facility
|
IP
|
$3.26
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.13
|
| Rate for Payer: Altius Commercial |
$3.13
|
| Rate for Payer: Beech Street Commercial |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.16
|
| Rate for Payer: Cigna of WY Commercial |
$3.19
|
| Rate for Payer: Entrust Commercial |
$3.10
|
| Rate for Payer: First Choice Health Commercial |
$3.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.15
|
| Rate for Payer: HealthUtah PPO |
$3.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.16
|
| Rate for Payer: Multiplan Medicare/VA |
$2.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3.19
|
| Rate for Payer: PacificSource Commercial |
$2.93
|
| Rate for Payer: PHCS PPO |
$3.19
|
| Rate for Payer: Three Rivers PPO |
$2.44
|
| Rate for Payer: TriWest Veterans Administration |
$2.15
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Medicare |
$2.15
|
| Rate for Payer: WINHealth Partners Commercial |
$3.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3.10
|
|
