|
SCR INTERFERENCE 8X30 4030P-08
|
Facility
|
OP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.91 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Aetna of WY Medicare |
$681.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$598.85
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$568.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$598.85
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$598.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,011.85
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENCE 9X20 4020P-09
|
Facility
|
OP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.91 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Aetna of WY Medicare |
$681.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$598.85
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$568.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$598.85
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$598.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,011.85
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENCE 9X20 4020P-09
|
Facility
|
IP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.38 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$681.45
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$647.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$681.45
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$681.45
|
| Rate for Payer: WINHealth Partners Commercial |
$980.88
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENCE 9X30 4030P-09
|
Facility
|
IP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.38 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$681.45
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$647.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$681.45
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$681.45
|
| Rate for Payer: WINHealth Partners Commercial |
$980.88
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR INTERFERENCE 9X30 4030P-09
|
Facility
|
OP
|
$1,032.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.91 |
| Max. Negotiated Rate |
$1,032.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,011.85
|
| Rate for Payer: Aetna of WY Medicare |
$681.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$991.20
|
| Rate for Payer: Altius Commercial |
$991.20
|
| Rate for Payer: Beech Street Commercial |
$1,011.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$847.68
|
| Rate for Payer: Cash Price |
$722.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,001.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,011.85
|
| Rate for Payer: Entrust Commercial |
$980.88
|
| Rate for Payer: First Choice Health Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$980.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$598.85
|
| Rate for Payer: HealthUtah PPO |
$1,032.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,001.52
|
| Rate for Payer: Multiplan Medicare/VA |
$568.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,011.85
|
| Rate for Payer: PacificSource Commercial |
$929.25
|
| Rate for Payer: PHCS PPO |
$1,011.85
|
| Rate for Payer: Three Rivers PPO |
$774.38
|
| Rate for Payer: TriWest Veterans Administration |
$598.85
|
| Rate for Payer: United Healthcare Commercial |
$898.28
|
| Rate for Payer: United Healthcare Medicare |
$598.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,011.85
|
| Rate for Payer: Wise Provider Network Commercial |
$980.88
|
|
|
SCR LOW PRO CAN 6.5X25 AR-1355
|
Facility
|
OP
|
$363.82
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.46 |
| Max. Negotiated Rate |
$363.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.54
|
| Rate for Payer: Aetna of WY Medicare |
$240.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$349.27
|
| Rate for Payer: Altius Commercial |
$349.27
|
| Rate for Payer: Beech Street Commercial |
$356.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.70
|
| Rate for Payer: Cash Price |
$254.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$352.91
|
| Rate for Payer: Cigna of WY Commercial |
$356.54
|
| Rate for Payer: Entrust Commercial |
$345.63
|
| Rate for Payer: First Choice Health Commercial |
$345.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.02
|
| Rate for Payer: HealthUtah PPO |
$363.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$352.91
|
| Rate for Payer: Multiplan Medicare/VA |
$200.46
|
| Rate for Payer: One Health Plan of WY PPO |
$356.54
|
| Rate for Payer: PacificSource Commercial |
$327.44
|
| Rate for Payer: PHCS PPO |
$356.54
|
| Rate for Payer: Three Rivers PPO |
$272.86
|
| Rate for Payer: TriWest Veterans Administration |
$211.02
|
| Rate for Payer: United Healthcare Commercial |
$316.52
|
| Rate for Payer: United Healthcare Medicare |
$211.02
|
| Rate for Payer: WINHealth Partners Commercial |
$356.54
|
| Rate for Payer: Wise Provider Network Commercial |
$345.63
|
|
|
SCR LOW PRO CAN 6.5X25 AR-1355
|
Facility
|
IP
|
$363.82
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.12 |
| Max. Negotiated Rate |
$363.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$349.27
|
| Rate for Payer: Altius Commercial |
$349.27
|
| Rate for Payer: Beech Street Commercial |
$356.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.70
|
| Rate for Payer: Cash Price |
$254.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$352.91
|
| Rate for Payer: Cigna of WY Commercial |
$356.54
|
| Rate for Payer: Entrust Commercial |
$345.63
|
| Rate for Payer: First Choice Health Commercial |
$345.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.12
|
| Rate for Payer: HealthUtah PPO |
$363.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$352.91
|
| Rate for Payer: Multiplan Medicare/VA |
$228.12
|
| Rate for Payer: One Health Plan of WY PPO |
$356.54
|
| Rate for Payer: PacificSource Commercial |
$327.44
|
| Rate for Payer: PHCS PPO |
$356.54
|
| Rate for Payer: Three Rivers PPO |
$272.86
|
| Rate for Payer: TriWest Veterans Administration |
$240.12
|
| Rate for Payer: United Healthcare Commercial |
$316.52
|
| Rate for Payer: United Healthcare Medicare |
$240.12
|
| Rate for Payer: WINHealth Partners Commercial |
$345.63
|
| Rate for Payer: Wise Provider Network Commercial |
$345.63
|
|
|
SCRUB PANTS LG - BLUE
|
Facility
|
IP
|
$16.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.72
|
| Rate for Payer: Altius Commercial |
$15.72
|
| Rate for Payer: Beech Street Commercial |
$16.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.89
|
| Rate for Payer: Cigna of WY Commercial |
$16.05
|
| Rate for Payer: Entrust Commercial |
$15.56
|
| Rate for Payer: First Choice Health Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.81
|
| Rate for Payer: HealthUtah PPO |
$16.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.89
|
| Rate for Payer: Multiplan Medicare/VA |
$10.27
|
| Rate for Payer: One Health Plan of WY PPO |
$16.05
|
| Rate for Payer: PacificSource Commercial |
$14.74
|
| Rate for Payer: PHCS PPO |
$16.05
|
| Rate for Payer: Three Rivers PPO |
$12.28
|
| Rate for Payer: TriWest Veterans Administration |
$10.81
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$10.81
|
| Rate for Payer: WINHealth Partners Commercial |
$15.56
|
| Rate for Payer: Wise Provider Network Commercial |
$15.56
|
|
|
SCRUB PANTS LG - BLUE
|
Facility
|
OP
|
$16.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.05
|
| Rate for Payer: Aetna of WY Medicare |
$10.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.72
|
| Rate for Payer: Altius Commercial |
$15.72
|
| Rate for Payer: Beech Street Commercial |
$16.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.89
|
| Rate for Payer: Cigna of WY Commercial |
$16.05
|
| Rate for Payer: Entrust Commercial |
$15.56
|
| Rate for Payer: First Choice Health Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.50
|
| Rate for Payer: HealthUtah PPO |
$16.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.89
|
| Rate for Payer: Multiplan Medicare/VA |
$9.03
|
| Rate for Payer: One Health Plan of WY PPO |
$16.05
|
| Rate for Payer: PacificSource Commercial |
$14.74
|
| Rate for Payer: PHCS PPO |
$16.05
|
| Rate for Payer: Three Rivers PPO |
$12.28
|
| Rate for Payer: TriWest Veterans Administration |
$9.50
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$9.50
|
| Rate for Payer: WINHealth Partners Commercial |
$16.05
|
| Rate for Payer: Wise Provider Network Commercial |
$15.56
|
|
|
SCRUB PANTS MED - GREEN
|
Facility
|
OP
|
$14.91
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.61
|
| Rate for Payer: Aetna of WY Medicare |
$9.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.31
|
| Rate for Payer: Altius Commercial |
$14.31
|
| Rate for Payer: Beech Street Commercial |
$14.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.24
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.46
|
| Rate for Payer: Cigna of WY Commercial |
$14.61
|
| Rate for Payer: Entrust Commercial |
$14.16
|
| Rate for Payer: First Choice Health Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.65
|
| Rate for Payer: HealthUtah PPO |
$14.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.46
|
| Rate for Payer: Multiplan Medicare/VA |
$8.22
|
| Rate for Payer: One Health Plan of WY PPO |
$14.61
|
| Rate for Payer: PacificSource Commercial |
$13.42
|
| Rate for Payer: PHCS PPO |
$14.61
|
| Rate for Payer: Three Rivers PPO |
$11.18
|
| Rate for Payer: TriWest Veterans Administration |
$8.65
|
| Rate for Payer: United Healthcare Commercial |
$12.97
|
| Rate for Payer: United Healthcare Medicare |
$8.65
|
| Rate for Payer: WINHealth Partners Commercial |
$14.61
|
| Rate for Payer: Wise Provider Network Commercial |
$14.16
|
|
|
SCRUB PANTS MED - GREEN
|
Facility
|
IP
|
$14.91
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.31
|
| Rate for Payer: Altius Commercial |
$14.31
|
| Rate for Payer: Beech Street Commercial |
$14.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.24
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.46
|
| Rate for Payer: Cigna of WY Commercial |
$14.61
|
| Rate for Payer: Entrust Commercial |
$14.16
|
| Rate for Payer: First Choice Health Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.84
|
| Rate for Payer: HealthUtah PPO |
$14.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.46
|
| Rate for Payer: Multiplan Medicare/VA |
$9.35
|
| Rate for Payer: One Health Plan of WY PPO |
$14.61
|
| Rate for Payer: PacificSource Commercial |
$13.42
|
| Rate for Payer: PHCS PPO |
$14.61
|
| Rate for Payer: Three Rivers PPO |
$11.18
|
| Rate for Payer: TriWest Veterans Administration |
$9.84
|
| Rate for Payer: United Healthcare Commercial |
$12.97
|
| Rate for Payer: United Healthcare Medicare |
$9.84
|
| Rate for Payer: WINHealth Partners Commercial |
$14.16
|
| Rate for Payer: Wise Provider Network Commercial |
$14.16
|
|
|
SCRUB PANTS SM - WHITE
|
Facility
|
IP
|
$14.49
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$14.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.91
|
| Rate for Payer: Altius Commercial |
$13.91
|
| Rate for Payer: Beech Street Commercial |
$14.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.90
|
| Rate for Payer: Cash Price |
$10.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.06
|
| Rate for Payer: Cigna of WY Commercial |
$14.20
|
| Rate for Payer: Entrust Commercial |
$13.77
|
| Rate for Payer: First Choice Health Commercial |
$13.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.56
|
| Rate for Payer: HealthUtah PPO |
$14.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.06
|
| Rate for Payer: Multiplan Medicare/VA |
$9.09
|
| Rate for Payer: One Health Plan of WY PPO |
$14.20
|
| Rate for Payer: PacificSource Commercial |
$13.04
|
| Rate for Payer: PHCS PPO |
$14.20
|
| Rate for Payer: Three Rivers PPO |
$10.87
|
| Rate for Payer: TriWest Veterans Administration |
$9.56
|
| Rate for Payer: United Healthcare Commercial |
$12.61
|
| Rate for Payer: United Healthcare Medicare |
$9.56
|
| Rate for Payer: WINHealth Partners Commercial |
$13.77
|
| Rate for Payer: Wise Provider Network Commercial |
$13.77
|
|
|
SCRUB PANTS SM - WHITE
|
Facility
|
OP
|
$14.49
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$14.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.20
|
| Rate for Payer: Aetna of WY Medicare |
$9.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.91
|
| Rate for Payer: Altius Commercial |
$13.91
|
| Rate for Payer: Beech Street Commercial |
$14.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.90
|
| Rate for Payer: Cash Price |
$10.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.06
|
| Rate for Payer: Cigna of WY Commercial |
$14.20
|
| Rate for Payer: Entrust Commercial |
$13.77
|
| Rate for Payer: First Choice Health Commercial |
$13.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.40
|
| Rate for Payer: HealthUtah PPO |
$14.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.06
|
| Rate for Payer: Multiplan Medicare/VA |
$7.98
|
| Rate for Payer: One Health Plan of WY PPO |
$14.20
|
| Rate for Payer: PacificSource Commercial |
$13.04
|
| Rate for Payer: PHCS PPO |
$14.20
|
| Rate for Payer: Three Rivers PPO |
$10.87
|
| Rate for Payer: TriWest Veterans Administration |
$8.40
|
| Rate for Payer: United Healthcare Commercial |
$12.61
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| Rate for Payer: WINHealth Partners Commercial |
$14.20
|
| Rate for Payer: Wise Provider Network Commercial |
$13.77
|
|
|
SCRUB PANTS XL - TAN
|
Facility
|
OP
|
$17.57
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Aetna of WY Medicare |
$11.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.87
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.19
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$9.68
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.19
|
| Rate for Payer: United Healthcare Commercial |
$15.29
|
| Rate for Payer: United Healthcare Medicare |
$10.19
|
| Rate for Payer: WINHealth Partners Commercial |
$17.22
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
SCRUB PANTS XL - TAN
|
Facility
|
IP
|
$17.57
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.87
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.60
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$11.02
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$11.60
|
| Rate for Payer: United Healthcare Commercial |
$15.29
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WINHealth Partners Commercial |
$16.69
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
SCRUB PANTS XXL - WINE
|
Facility
|
IP
|
$18.16
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.43
|
| Rate for Payer: Altius Commercial |
$17.43
|
| Rate for Payer: Beech Street Commercial |
$17.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.91
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.62
|
| Rate for Payer: Cigna of WY Commercial |
$17.80
|
| Rate for Payer: Entrust Commercial |
$17.25
|
| Rate for Payer: First Choice Health Commercial |
$17.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.99
|
| Rate for Payer: HealthUtah PPO |
$18.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.62
|
| Rate for Payer: Multiplan Medicare/VA |
$11.39
|
| Rate for Payer: One Health Plan of WY PPO |
$17.80
|
| Rate for Payer: PacificSource Commercial |
$16.34
|
| Rate for Payer: PHCS PPO |
$17.80
|
| Rate for Payer: Three Rivers PPO |
$13.62
|
| Rate for Payer: TriWest Veterans Administration |
$11.99
|
| Rate for Payer: United Healthcare Commercial |
$15.80
|
| Rate for Payer: United Healthcare Medicare |
$11.99
|
| Rate for Payer: WINHealth Partners Commercial |
$17.25
|
| Rate for Payer: Wise Provider Network Commercial |
$17.25
|
|
|
SCRUB PANTS XXL - WINE
|
Facility
|
OP
|
$18.16
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.80
|
| Rate for Payer: Aetna of WY Medicare |
$11.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.43
|
| Rate for Payer: Altius Commercial |
$17.43
|
| Rate for Payer: Beech Street Commercial |
$17.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.91
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.62
|
| Rate for Payer: Cigna of WY Commercial |
$17.80
|
| Rate for Payer: Entrust Commercial |
$17.25
|
| Rate for Payer: First Choice Health Commercial |
$17.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.53
|
| Rate for Payer: HealthUtah PPO |
$18.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.62
|
| Rate for Payer: Multiplan Medicare/VA |
$10.01
|
| Rate for Payer: One Health Plan of WY PPO |
$17.80
|
| Rate for Payer: PacificSource Commercial |
$16.34
|
| Rate for Payer: PHCS PPO |
$17.80
|
| Rate for Payer: Three Rivers PPO |
$13.62
|
| Rate for Payer: TriWest Veterans Administration |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$15.80
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
| Rate for Payer: WINHealth Partners Commercial |
$17.80
|
| Rate for Payer: Wise Provider Network Commercial |
$17.25
|
|
|
SCRUB TOP LG - BLUE
|
Facility
|
OP
|
$14.11
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.83
|
| Rate for Payer: Aetna of WY Medicare |
$9.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.55
|
| Rate for Payer: Altius Commercial |
$13.55
|
| Rate for Payer: Beech Street Commercial |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.58
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.69
|
| Rate for Payer: Cigna of WY Commercial |
$13.83
|
| Rate for Payer: Entrust Commercial |
$13.40
|
| Rate for Payer: First Choice Health Commercial |
$13.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.18
|
| Rate for Payer: HealthUtah PPO |
$14.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.69
|
| Rate for Payer: Multiplan Medicare/VA |
$7.77
|
| Rate for Payer: One Health Plan of WY PPO |
$13.83
|
| Rate for Payer: PacificSource Commercial |
$12.70
|
| Rate for Payer: PHCS PPO |
$13.83
|
| Rate for Payer: Three Rivers PPO |
$10.58
|
| Rate for Payer: TriWest Veterans Administration |
$8.18
|
| Rate for Payer: United Healthcare Commercial |
$12.28
|
| Rate for Payer: United Healthcare Medicare |
$8.18
|
| Rate for Payer: WINHealth Partners Commercial |
$13.83
|
| Rate for Payer: Wise Provider Network Commercial |
$13.40
|
|
|
SCRUB TOP LG - BLUE
|
Facility
|
IP
|
$14.11
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.55
|
| Rate for Payer: Altius Commercial |
$13.55
|
| Rate for Payer: Beech Street Commercial |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.58
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.69
|
| Rate for Payer: Cigna of WY Commercial |
$13.83
|
| Rate for Payer: Entrust Commercial |
$13.40
|
| Rate for Payer: First Choice Health Commercial |
$13.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$14.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.69
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: One Health Plan of WY PPO |
$13.83
|
| Rate for Payer: PacificSource Commercial |
$12.70
|
| Rate for Payer: PHCS PPO |
$13.83
|
| Rate for Payer: Three Rivers PPO |
$10.58
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$12.28
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$13.40
|
| Rate for Payer: Wise Provider Network Commercial |
$13.40
|
|
|
SCRUB TOP MED - GREEN
|
Facility
|
OP
|
$10.68
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$10.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.47
|
| Rate for Payer: Aetna of WY Medicare |
$7.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.25
|
| Rate for Payer: Altius Commercial |
$10.25
|
| Rate for Payer: Beech Street Commercial |
$10.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.77
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.36
|
| Rate for Payer: Cigna of WY Commercial |
$10.47
|
| Rate for Payer: Entrust Commercial |
$10.15
|
| Rate for Payer: First Choice Health Commercial |
$10.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.19
|
| Rate for Payer: HealthUtah PPO |
$10.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.36
|
| Rate for Payer: Multiplan Medicare/VA |
$5.88
|
| Rate for Payer: One Health Plan of WY PPO |
$10.47
|
| Rate for Payer: PacificSource Commercial |
$9.61
|
| Rate for Payer: PHCS PPO |
$10.47
|
| Rate for Payer: Three Rivers PPO |
$8.01
|
| Rate for Payer: TriWest Veterans Administration |
$6.19
|
| Rate for Payer: United Healthcare Commercial |
$9.29
|
| Rate for Payer: United Healthcare Medicare |
$6.19
|
| Rate for Payer: WINHealth Partners Commercial |
$10.47
|
| Rate for Payer: Wise Provider Network Commercial |
$10.15
|
|
|
SCRUB TOP MED - GREEN
|
Facility
|
IP
|
$10.68
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$10.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.25
|
| Rate for Payer: Altius Commercial |
$10.25
|
| Rate for Payer: Beech Street Commercial |
$10.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.77
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.36
|
| Rate for Payer: Cigna of WY Commercial |
$10.47
|
| Rate for Payer: Entrust Commercial |
$10.15
|
| Rate for Payer: First Choice Health Commercial |
$10.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.05
|
| Rate for Payer: HealthUtah PPO |
$10.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.36
|
| Rate for Payer: Multiplan Medicare/VA |
$6.70
|
| Rate for Payer: One Health Plan of WY PPO |
$10.47
|
| Rate for Payer: PacificSource Commercial |
$9.61
|
| Rate for Payer: PHCS PPO |
$10.47
|
| Rate for Payer: Three Rivers PPO |
$8.01
|
| Rate for Payer: TriWest Veterans Administration |
$7.05
|
| Rate for Payer: United Healthcare Commercial |
$9.29
|
| Rate for Payer: United Healthcare Medicare |
$7.05
|
| Rate for Payer: WINHealth Partners Commercial |
$10.15
|
| Rate for Payer: Wise Provider Network Commercial |
$10.15
|
|
|
SCRUB TOP SM - WHITE
|
Facility
|
IP
|
$12.85
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.34
|
| Rate for Payer: Altius Commercial |
$12.34
|
| Rate for Payer: Beech Street Commercial |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.55
|
| Rate for Payer: Cash Price |
$8.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.46
|
| Rate for Payer: Cigna of WY Commercial |
$12.59
|
| Rate for Payer: Entrust Commercial |
$12.21
|
| Rate for Payer: First Choice Health Commercial |
$12.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.48
|
| Rate for Payer: HealthUtah PPO |
$12.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.46
|
| Rate for Payer: Multiplan Medicare/VA |
$8.06
|
| Rate for Payer: One Health Plan of WY PPO |
$12.59
|
| Rate for Payer: PacificSource Commercial |
$11.56
|
| Rate for Payer: PHCS PPO |
$12.59
|
| Rate for Payer: Three Rivers PPO |
$9.64
|
| Rate for Payer: TriWest Veterans Administration |
$8.48
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare |
$8.48
|
| Rate for Payer: WINHealth Partners Commercial |
$12.21
|
| Rate for Payer: Wise Provider Network Commercial |
$12.21
|
|
|
SCRUB TOP SM - WHITE
|
Facility
|
OP
|
$12.85
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.59
|
| Rate for Payer: Aetna of WY Medicare |
$8.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.34
|
| Rate for Payer: Altius Commercial |
$12.34
|
| Rate for Payer: Beech Street Commercial |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.55
|
| Rate for Payer: Cash Price |
$8.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.46
|
| Rate for Payer: Cigna of WY Commercial |
$12.59
|
| Rate for Payer: Entrust Commercial |
$12.21
|
| Rate for Payer: First Choice Health Commercial |
$12.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.45
|
| Rate for Payer: HealthUtah PPO |
$12.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.46
|
| Rate for Payer: Multiplan Medicare/VA |
$7.08
|
| Rate for Payer: One Health Plan of WY PPO |
$12.59
|
| Rate for Payer: PacificSource Commercial |
$11.56
|
| Rate for Payer: PHCS PPO |
$12.59
|
| Rate for Payer: Three Rivers PPO |
$9.64
|
| Rate for Payer: TriWest Veterans Administration |
$7.45
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare |
$7.45
|
| Rate for Payer: WINHealth Partners Commercial |
$12.59
|
| Rate for Payer: Wise Provider Network Commercial |
$12.21
|
|
|
SCRUB TOP XL - TAN
|
Facility
|
IP
|
$15.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.72
|
| Rate for Payer: Altius Commercial |
$14.72
|
| Rate for Payer: Beech Street Commercial |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.59
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.87
|
| Rate for Payer: Cigna of WY Commercial |
$15.02
|
| Rate for Payer: Entrust Commercial |
$14.56
|
| Rate for Payer: First Choice Health Commercial |
$14.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.12
|
| Rate for Payer: HealthUtah PPO |
$15.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.87
|
| Rate for Payer: Multiplan Medicare/VA |
$9.61
|
| Rate for Payer: One Health Plan of WY PPO |
$15.02
|
| Rate for Payer: PacificSource Commercial |
$13.80
|
| Rate for Payer: PHCS PPO |
$15.02
|
| Rate for Payer: Three Rivers PPO |
$11.50
|
| Rate for Payer: TriWest Veterans Administration |
$10.12
|
| Rate for Payer: United Healthcare Commercial |
$13.34
|
| Rate for Payer: United Healthcare Medicare |
$10.12
|
| Rate for Payer: WINHealth Partners Commercial |
$14.56
|
| Rate for Payer: Wise Provider Network Commercial |
$14.56
|
|
|
SCRUB TOP XL - TAN
|
Facility
|
OP
|
$15.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.02
|
| Rate for Payer: Aetna of WY Medicare |
$10.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.72
|
| Rate for Payer: Altius Commercial |
$14.72
|
| Rate for Payer: Beech Street Commercial |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.59
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.87
|
| Rate for Payer: Cigna of WY Commercial |
$15.02
|
| Rate for Payer: Entrust Commercial |
$14.56
|
| Rate for Payer: First Choice Health Commercial |
$14.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.89
|
| Rate for Payer: HealthUtah PPO |
$15.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.87
|
| Rate for Payer: Multiplan Medicare/VA |
$8.45
|
| Rate for Payer: One Health Plan of WY PPO |
$15.02
|
| Rate for Payer: PacificSource Commercial |
$13.80
|
| Rate for Payer: PHCS PPO |
$15.02
|
| Rate for Payer: Three Rivers PPO |
$11.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.89
|
| Rate for Payer: United Healthcare Commercial |
$13.34
|
| Rate for Payer: United Healthcare Medicare |
$8.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.02
|
| Rate for Payer: Wise Provider Network Commercial |
$14.56
|
|
