|
SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Professional
|
Both
|
$10,209.00
|
|
|
Service Code
|
HCPCS 69706
|
| Hospital Charge Code |
69706
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$10,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,004.82
|
| Rate for Payer: Aetna of WY Medicare |
$232.10
|
| Rate for Payer: Beech Street Commercial |
$9,698.55
|
| Rate for Payer: Cash Price |
$7,146.30
|
| Rate for Payer: Cash Price |
$7,146.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,902.73
|
| Rate for Payer: Cigna of WY Commercial |
$10,004.82
|
| Rate for Payer: First Choice Health Commercial |
$9,188.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,698.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.10
|
| Rate for Payer: HealthUtah PPO |
$10,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,902.73
|
| Rate for Payer: Multiplan Medicare/VA |
$197.28
|
| Rate for Payer: One Health Plan of WY PPO |
$10,004.82
|
| Rate for Payer: PacificSource Commercial |
$9,188.10
|
| Rate for Payer: PHCS PPO |
$9,698.55
|
| Rate for Payer: Three Rivers PPO |
$7,656.75
|
| Rate for Payer: TriWest Veterans Administration |
$232.10
|
| Rate for Payer: United Healthcare Commercial |
$8,881.83
|
| Rate for Payer: United Healthcare Medicare |
$232.10
|
| Rate for Payer: WINHealth Partners Commercial |
$8,677.65
|
|
|
SUT 4-0 FIBERLOOP NEEDLE
|
Facility
|
OP
|
$204.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.62 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.31
|
| Rate for Payer: Aetna of WY Medicare |
$134.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.22
|
| Rate for Payer: Altius Commercial |
$196.22
|
| Rate for Payer: Beech Street Commercial |
$200.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$143.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.27
|
| Rate for Payer: Cigna of WY Commercial |
$200.31
|
| Rate for Payer: Entrust Commercial |
$194.18
|
| Rate for Payer: First Choice Health Commercial |
$194.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.55
|
| Rate for Payer: HealthUtah PPO |
$204.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.27
|
| Rate for Payer: Multiplan Medicare/VA |
$112.62
|
| Rate for Payer: One Health Plan of WY PPO |
$200.31
|
| Rate for Payer: PacificSource Commercial |
$183.96
|
| Rate for Payer: PHCS PPO |
$200.31
|
| Rate for Payer: Three Rivers PPO |
$153.30
|
| Rate for Payer: TriWest Veterans Administration |
$118.55
|
| Rate for Payer: United Healthcare Commercial |
$177.83
|
| Rate for Payer: United Healthcare Medicare |
$118.55
|
| Rate for Payer: WINHealth Partners Commercial |
$200.31
|
| Rate for Payer: Wise Provider Network Commercial |
$194.18
|
|
|
SUT 4-0 FIBERLOOP NEEDLE
|
Facility
|
IP
|
$204.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.16 |
| Max. Negotiated Rate |
$204.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$200.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$196.22
|
| Rate for Payer: Altius Commercial |
$196.22
|
| Rate for Payer: Beech Street Commercial |
$200.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.81
|
| Rate for Payer: Cash Price |
$143.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$198.27
|
| Rate for Payer: Cigna of WY Commercial |
$200.31
|
| Rate for Payer: Entrust Commercial |
$194.18
|
| Rate for Payer: First Choice Health Commercial |
$194.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$194.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.90
|
| Rate for Payer: HealthUtah PPO |
$204.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$198.27
|
| Rate for Payer: Multiplan Medicare/VA |
$128.16
|
| Rate for Payer: One Health Plan of WY PPO |
$200.31
|
| Rate for Payer: PacificSource Commercial |
$183.96
|
| Rate for Payer: PHCS PPO |
$200.31
|
| Rate for Payer: Three Rivers PPO |
$153.30
|
| Rate for Payer: TriWest Veterans Administration |
$134.90
|
| Rate for Payer: United Healthcare Commercial |
$177.83
|
| Rate for Payer: United Healthcare Medicare |
$134.90
|
| Rate for Payer: WINHealth Partners Commercial |
$194.18
|
| Rate for Payer: Wise Provider Network Commercial |
$194.18
|
|
|
SUT ANCHOR 4.75X14 1927PST-475
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.12 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$482.12
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$507.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$507.50
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
SUT ANCHOR 4.75X14 1927PST-475
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$548.62
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
SUT ANCHOR CORKSCREW 1928SF-45
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.56 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Aetna of WY Medicare |
$531.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$772.80
|
| Rate for Payer: Altius Commercial |
$772.80
|
| Rate for Payer: Beech Street Commercial |
$788.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$660.90
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: Entrust Commercial |
$764.75
|
| Rate for Payer: First Choice Health Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$466.90
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: Multiplan Medicare/VA |
$443.56
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$788.90
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: TriWest Veterans Administration |
$466.90
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: United Healthcare Medicare |
$466.90
|
| Rate for Payer: WINHealth Partners Commercial |
$788.90
|
| Rate for Payer: Wise Provider Network Commercial |
$764.75
|
|
|
SUT ANCHOR CORKSCREW 1928SF-45
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.74 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$788.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$772.80
|
| Rate for Payer: Altius Commercial |
$772.80
|
| Rate for Payer: Beech Street Commercial |
$788.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$660.90
|
| Rate for Payer: Cash Price |
$563.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$780.85
|
| Rate for Payer: Cigna of WY Commercial |
$788.90
|
| Rate for Payer: Entrust Commercial |
$764.75
|
| Rate for Payer: First Choice Health Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$764.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$531.30
|
| Rate for Payer: HealthUtah PPO |
$805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$780.85
|
| Rate for Payer: Multiplan Medicare/VA |
$504.74
|
| Rate for Payer: One Health Plan of WY PPO |
$788.90
|
| Rate for Payer: PacificSource Commercial |
$724.50
|
| Rate for Payer: PHCS PPO |
$788.90
|
| Rate for Payer: Three Rivers PPO |
$603.75
|
| Rate for Payer: TriWest Veterans Administration |
$531.30
|
| Rate for Payer: United Healthcare Commercial |
$700.35
|
| Rate for Payer: United Healthcare Medicare |
$531.30
|
| Rate for Payer: WINHealth Partners Commercial |
$764.75
|
| Rate for Payer: Wise Provider Network Commercial |
$764.75
|
|
|
SUT ANCHOR CORKSCREW 3.5X10MM
|
Facility
|
OP
|
$1,165.08
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.96 |
| Max. Negotiated Rate |
$1,165.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.78
|
| Rate for Payer: Aetna of WY Medicare |
$768.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,118.48
|
| Rate for Payer: Altius Commercial |
$1,118.48
|
| Rate for Payer: Beech Street Commercial |
$1,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$956.53
|
| Rate for Payer: Cash Price |
$815.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.78
|
| Rate for Payer: Entrust Commercial |
$1,106.83
|
| Rate for Payer: First Choice Health Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$675.75
|
| Rate for Payer: HealthUtah PPO |
$1,165.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.13
|
| Rate for Payer: Multiplan Medicare/VA |
$641.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.78
|
| Rate for Payer: PacificSource Commercial |
$1,048.57
|
| Rate for Payer: PHCS PPO |
$1,141.78
|
| Rate for Payer: Three Rivers PPO |
$873.81
|
| Rate for Payer: TriWest Veterans Administration |
$675.75
|
| Rate for Payer: United Healthcare Commercial |
$1,013.62
|
| Rate for Payer: United Healthcare Medicare |
$675.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,141.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.83
|
|
|
SUT ANCHOR CORKSCREW 3.5X10MM
|
Facility
|
IP
|
$1,165.08
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.51 |
| Max. Negotiated Rate |
$1,165.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,118.48
|
| Rate for Payer: Altius Commercial |
$1,118.48
|
| Rate for Payer: Beech Street Commercial |
$1,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$956.53
|
| Rate for Payer: Cash Price |
$815.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.78
|
| Rate for Payer: Entrust Commercial |
$1,106.83
|
| Rate for Payer: First Choice Health Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$768.95
|
| Rate for Payer: HealthUtah PPO |
$1,165.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.13
|
| Rate for Payer: Multiplan Medicare/VA |
$730.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.78
|
| Rate for Payer: PacificSource Commercial |
$1,048.57
|
| Rate for Payer: PHCS PPO |
$1,141.78
|
| Rate for Payer: Three Rivers PPO |
$873.81
|
| Rate for Payer: TriWest Veterans Administration |
$768.95
|
| Rate for Payer: United Healthcare Commercial |
$1,013.62
|
| Rate for Payer: United Healthcare Medicare |
$768.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,106.83
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.83
|
|
|
SUT ANCHOR MICRO CORKSCREW 2.2X4MM
|
Facility
|
IP
|
$1,165.08
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.51 |
| Max. Negotiated Rate |
$1,165.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,118.48
|
| Rate for Payer: Altius Commercial |
$1,118.48
|
| Rate for Payer: Beech Street Commercial |
$1,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$956.53
|
| Rate for Payer: Cash Price |
$815.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.78
|
| Rate for Payer: Entrust Commercial |
$1,106.83
|
| Rate for Payer: First Choice Health Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$768.95
|
| Rate for Payer: HealthUtah PPO |
$1,165.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.13
|
| Rate for Payer: Multiplan Medicare/VA |
$730.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.78
|
| Rate for Payer: PacificSource Commercial |
$1,048.57
|
| Rate for Payer: PHCS PPO |
$1,141.78
|
| Rate for Payer: Three Rivers PPO |
$873.81
|
| Rate for Payer: TriWest Veterans Administration |
$768.95
|
| Rate for Payer: United Healthcare Commercial |
$1,013.62
|
| Rate for Payer: United Healthcare Medicare |
$768.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,106.83
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.83
|
|
|
SUT ANCHOR MICRO CORKSCREW 2.2X4MM
|
Facility
|
OP
|
$1,165.08
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.96 |
| Max. Negotiated Rate |
$1,165.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.78
|
| Rate for Payer: Aetna of WY Medicare |
$768.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,118.48
|
| Rate for Payer: Altius Commercial |
$1,118.48
|
| Rate for Payer: Beech Street Commercial |
$1,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$956.53
|
| Rate for Payer: Cash Price |
$815.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.78
|
| Rate for Payer: Entrust Commercial |
$1,106.83
|
| Rate for Payer: First Choice Health Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$675.75
|
| Rate for Payer: HealthUtah PPO |
$1,165.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.13
|
| Rate for Payer: Multiplan Medicare/VA |
$641.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.78
|
| Rate for Payer: PacificSource Commercial |
$1,048.57
|
| Rate for Payer: PHCS PPO |
$1,141.78
|
| Rate for Payer: Three Rivers PPO |
$873.81
|
| Rate for Payer: TriWest Veterans Administration |
$675.75
|
| Rate for Payer: United Healthcare Commercial |
$1,013.62
|
| Rate for Payer: United Healthcare Medicare |
$675.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,141.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.83
|
|
|
SUT ANCHOR MINI CORKSCREW 2.7X7MM
|
Facility
|
IP
|
$1,165.08
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.51 |
| Max. Negotiated Rate |
$1,165.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,118.48
|
| Rate for Payer: Altius Commercial |
$1,118.48
|
| Rate for Payer: Beech Street Commercial |
$1,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$956.53
|
| Rate for Payer: Cash Price |
$815.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.78
|
| Rate for Payer: Entrust Commercial |
$1,106.83
|
| Rate for Payer: First Choice Health Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$768.95
|
| Rate for Payer: HealthUtah PPO |
$1,165.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.13
|
| Rate for Payer: Multiplan Medicare/VA |
$730.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.78
|
| Rate for Payer: PacificSource Commercial |
$1,048.57
|
| Rate for Payer: PHCS PPO |
$1,141.78
|
| Rate for Payer: Three Rivers PPO |
$873.81
|
| Rate for Payer: TriWest Veterans Administration |
$768.95
|
| Rate for Payer: United Healthcare Commercial |
$1,013.62
|
| Rate for Payer: United Healthcare Medicare |
$768.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,106.83
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.83
|
|
|
SUT ANCHOR MINI CORKSCREW 2.7X7MM
|
Facility
|
OP
|
$1,165.08
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.96 |
| Max. Negotiated Rate |
$1,165.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,141.78
|
| Rate for Payer: Aetna of WY Medicare |
$768.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,118.48
|
| Rate for Payer: Altius Commercial |
$1,118.48
|
| Rate for Payer: Beech Street Commercial |
$1,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$956.53
|
| Rate for Payer: Cash Price |
$815.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,130.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,141.78
|
| Rate for Payer: Entrust Commercial |
$1,106.83
|
| Rate for Payer: First Choice Health Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$675.75
|
| Rate for Payer: HealthUtah PPO |
$1,165.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,130.13
|
| Rate for Payer: Multiplan Medicare/VA |
$641.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,141.78
|
| Rate for Payer: PacificSource Commercial |
$1,048.57
|
| Rate for Payer: PHCS PPO |
$1,141.78
|
| Rate for Payer: Three Rivers PPO |
$873.81
|
| Rate for Payer: TriWest Veterans Administration |
$675.75
|
| Rate for Payer: United Healthcare Commercial |
$1,013.62
|
| Rate for Payer: United Healthcare Medicare |
$675.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,141.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.83
|
|
|
SUT BTB TIGHTROPE II
|
Facility
|
OP
|
$2,227.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.61 |
| Max. Negotiated Rate |
$2,227.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,183.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,470.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,138.84
|
| Rate for Payer: Altius Commercial |
$2,138.84
|
| Rate for Payer: Beech Street Commercial |
$2,183.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,829.16
|
| Rate for Payer: Cash Price |
$1,559.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,161.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,183.40
|
| Rate for Payer: Entrust Commercial |
$2,116.56
|
| Rate for Payer: First Choice Health Commercial |
$2,116.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,116.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,292.22
|
| Rate for Payer: HealthUtah PPO |
$2,227.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,161.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1,227.61
|
| Rate for Payer: One Health Plan of WY PPO |
$2,183.40
|
| Rate for Payer: PacificSource Commercial |
$2,005.16
|
| Rate for Payer: PHCS PPO |
$2,183.40
|
| Rate for Payer: Three Rivers PPO |
$1,670.97
|
| Rate for Payer: TriWest Veterans Administration |
$1,292.22
|
| Rate for Payer: United Healthcare Commercial |
$1,938.33
|
| Rate for Payer: United Healthcare Medicare |
$1,292.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,183.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,116.56
|
|
|
SUT BTB TIGHTROPE II
|
Facility
|
IP
|
$2,227.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.93 |
| Max. Negotiated Rate |
$2,227.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,183.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,138.84
|
| Rate for Payer: Altius Commercial |
$2,138.84
|
| Rate for Payer: Beech Street Commercial |
$2,183.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,829.16
|
| Rate for Payer: Cash Price |
$1,559.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,161.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,183.40
|
| Rate for Payer: Entrust Commercial |
$2,116.56
|
| Rate for Payer: First Choice Health Commercial |
$2,116.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,116.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,470.45
|
| Rate for Payer: HealthUtah PPO |
$2,227.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,161.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1,396.93
|
| Rate for Payer: One Health Plan of WY PPO |
$2,183.40
|
| Rate for Payer: PacificSource Commercial |
$2,005.16
|
| Rate for Payer: PHCS PPO |
$2,183.40
|
| Rate for Payer: Three Rivers PPO |
$1,670.97
|
| Rate for Payer: TriWest Veterans Administration |
$1,470.45
|
| Rate for Payer: United Healthcare Commercial |
$1,938.33
|
| Rate for Payer: United Healthcare Medicare |
$1,470.45
|
| Rate for Payer: WINHealth Partners Commercial |
$2,116.56
|
| Rate for Payer: Wise Provider Network Commercial |
$2,116.56
|
|
|
SUT CHROMIC BLUNT 27" BP 48G
|
Facility
|
IP
|
$25.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$25.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.03
|
| Rate for Payer: Altius Commercial |
$24.03
|
| Rate for Payer: Beech Street Commercial |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.55
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.28
|
| Rate for Payer: Cigna of WY Commercial |
$24.53
|
| Rate for Payer: Entrust Commercial |
$23.78
|
| Rate for Payer: First Choice Health Commercial |
$23.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.52
|
| Rate for Payer: HealthUtah PPO |
$25.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.28
|
| Rate for Payer: Multiplan Medicare/VA |
$15.69
|
| Rate for Payer: One Health Plan of WY PPO |
$24.53
|
| Rate for Payer: PacificSource Commercial |
$22.53
|
| Rate for Payer: PHCS PPO |
$24.53
|
| Rate for Payer: Three Rivers PPO |
$18.77
|
| Rate for Payer: TriWest Veterans Administration |
$16.52
|
| Rate for Payer: United Healthcare Commercial |
$21.78
|
| Rate for Payer: United Healthcare Medicare |
$16.52
|
| Rate for Payer: WINHealth Partners Commercial |
$23.78
|
| Rate for Payer: Wise Provider Network Commercial |
$23.78
|
|
|
SUT CHROMIC BLUNT 27" BP 48G
|
Facility
|
OP
|
$25.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$25.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.53
|
| Rate for Payer: Aetna of WY Medicare |
$16.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.03
|
| Rate for Payer: Altius Commercial |
$24.03
|
| Rate for Payer: Beech Street Commercial |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.55
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.28
|
| Rate for Payer: Cigna of WY Commercial |
$24.53
|
| Rate for Payer: Entrust Commercial |
$23.78
|
| Rate for Payer: First Choice Health Commercial |
$23.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.52
|
| Rate for Payer: HealthUtah PPO |
$25.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.28
|
| Rate for Payer: Multiplan Medicare/VA |
$13.79
|
| Rate for Payer: One Health Plan of WY PPO |
$24.53
|
| Rate for Payer: PacificSource Commercial |
$22.53
|
| Rate for Payer: PHCS PPO |
$24.53
|
| Rate for Payer: Three Rivers PPO |
$18.77
|
| Rate for Payer: TriWest Veterans Administration |
$14.52
|
| Rate for Payer: United Healthcare Commercial |
$21.78
|
| Rate for Payer: United Healthcare Medicare |
$14.52
|
| Rate for Payer: WINHealth Partners Commercial |
$24.53
|
| Rate for Payer: Wise Provider Network Commercial |
$23.78
|
|
|
SUT CHROMIC GUT 4-0 P2 1659G
|
Facility
|
OP
|
$16.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.83
|
| Rate for Payer: Aetna of WY Medicare |
$10.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.50
|
| Rate for Payer: Altius Commercial |
$15.50
|
| Rate for Payer: Beech Street Commercial |
$15.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.26
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.67
|
| Rate for Payer: Cigna of WY Commercial |
$15.83
|
| Rate for Payer: Entrust Commercial |
$15.34
|
| Rate for Payer: First Choice Health Commercial |
$15.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.37
|
| Rate for Payer: HealthUtah PPO |
$16.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.67
|
| Rate for Payer: Multiplan Medicare/VA |
$8.90
|
| Rate for Payer: One Health Plan of WY PPO |
$15.83
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.83
|
| Rate for Payer: Three Rivers PPO |
$12.11
|
| Rate for Payer: TriWest Veterans Administration |
$9.37
|
| Rate for Payer: United Healthcare Commercial |
$14.05
|
| Rate for Payer: United Healthcare Medicare |
$9.37
|
| Rate for Payer: WINHealth Partners Commercial |
$15.83
|
| Rate for Payer: Wise Provider Network Commercial |
$15.34
|
|
|
SUT CHROMIC GUT 4-0 P2 1659G
|
Facility
|
IP
|
$16.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.50
|
| Rate for Payer: Altius Commercial |
$15.50
|
| Rate for Payer: Beech Street Commercial |
$15.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.26
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.67
|
| Rate for Payer: Cigna of WY Commercial |
$15.83
|
| Rate for Payer: Entrust Commercial |
$15.34
|
| Rate for Payer: First Choice Health Commercial |
$15.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$16.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.67
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$15.83
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.83
|
| Rate for Payer: Three Rivers PPO |
$12.11
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$14.05
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$15.34
|
| Rate for Payer: Wise Provider Network Commercial |
$15.34
|
|
|
SUT CHROMIC GUT TP-1 M760G
|
Facility
|
OP
|
$59.17
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.99
|
| Rate for Payer: Aetna of WY Medicare |
$39.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.80
|
| Rate for Payer: Altius Commercial |
$56.80
|
| Rate for Payer: Beech Street Commercial |
$57.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.58
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.39
|
| Rate for Payer: Cigna of WY Commercial |
$57.99
|
| Rate for Payer: Entrust Commercial |
$56.21
|
| Rate for Payer: First Choice Health Commercial |
$56.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.32
|
| Rate for Payer: HealthUtah PPO |
$59.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.39
|
| Rate for Payer: Multiplan Medicare/VA |
$32.60
|
| Rate for Payer: One Health Plan of WY PPO |
$57.99
|
| Rate for Payer: PacificSource Commercial |
$53.25
|
| Rate for Payer: PHCS PPO |
$57.99
|
| Rate for Payer: Three Rivers PPO |
$44.38
|
| Rate for Payer: TriWest Veterans Administration |
$34.32
|
| Rate for Payer: United Healthcare Commercial |
$51.48
|
| Rate for Payer: United Healthcare Medicare |
$34.32
|
| Rate for Payer: WINHealth Partners Commercial |
$57.99
|
| Rate for Payer: Wise Provider Network Commercial |
$56.21
|
|
|
SUT CHROMIC GUT TP-1 M760G
|
Facility
|
IP
|
$59.17
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.80
|
| Rate for Payer: Altius Commercial |
$56.80
|
| Rate for Payer: Beech Street Commercial |
$57.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.58
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.39
|
| Rate for Payer: Cigna of WY Commercial |
$57.99
|
| Rate for Payer: Entrust Commercial |
$56.21
|
| Rate for Payer: First Choice Health Commercial |
$56.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.05
|
| Rate for Payer: HealthUtah PPO |
$59.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.39
|
| Rate for Payer: Multiplan Medicare/VA |
$37.10
|
| Rate for Payer: One Health Plan of WY PPO |
$57.99
|
| Rate for Payer: PacificSource Commercial |
$53.25
|
| Rate for Payer: PHCS PPO |
$57.99
|
| Rate for Payer: Three Rivers PPO |
$44.38
|
| Rate for Payer: TriWest Veterans Administration |
$39.05
|
| Rate for Payer: United Healthcare Commercial |
$51.48
|
| Rate for Payer: United Healthcare Medicare |
$39.05
|
| Rate for Payer: WINHealth Partners Commercial |
$56.21
|
| Rate for Payer: Wise Provider Network Commercial |
$56.21
|
|
|
SUT CORZA CHROMIC 4-0 P-3
|
Facility
|
IP
|
$26.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$26.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.78
|
| Rate for Payer: Altius Commercial |
$25.78
|
| Rate for Payer: Beech Street Commercial |
$26.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.04
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.04
|
| Rate for Payer: Cigna of WY Commercial |
$26.31
|
| Rate for Payer: Entrust Commercial |
$25.51
|
| Rate for Payer: First Choice Health Commercial |
$25.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.72
|
| Rate for Payer: HealthUtah PPO |
$26.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.04
|
| Rate for Payer: Multiplan Medicare/VA |
$16.83
|
| Rate for Payer: One Health Plan of WY PPO |
$26.31
|
| Rate for Payer: PacificSource Commercial |
$24.16
|
| Rate for Payer: PHCS PPO |
$26.31
|
| Rate for Payer: Three Rivers PPO |
$20.14
|
| Rate for Payer: TriWest Veterans Administration |
$17.72
|
| Rate for Payer: United Healthcare Commercial |
$23.36
|
| Rate for Payer: United Healthcare Medicare |
$17.72
|
| Rate for Payer: WINHealth Partners Commercial |
$25.51
|
| Rate for Payer: Wise Provider Network Commercial |
$25.51
|
|
|
SUT CORZA CHROMIC 4-0 P-3
|
Facility
|
OP
|
$26.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$26.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.31
|
| Rate for Payer: Aetna of WY Medicare |
$17.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.78
|
| Rate for Payer: Altius Commercial |
$25.78
|
| Rate for Payer: Beech Street Commercial |
$26.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.04
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.04
|
| Rate for Payer: Cigna of WY Commercial |
$26.31
|
| Rate for Payer: Entrust Commercial |
$25.51
|
| Rate for Payer: First Choice Health Commercial |
$25.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.57
|
| Rate for Payer: HealthUtah PPO |
$26.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.04
|
| Rate for Payer: Multiplan Medicare/VA |
$14.79
|
| Rate for Payer: One Health Plan of WY PPO |
$26.31
|
| Rate for Payer: PacificSource Commercial |
$24.16
|
| Rate for Payer: PHCS PPO |
$26.31
|
| Rate for Payer: Three Rivers PPO |
$20.14
|
| Rate for Payer: TriWest Veterans Administration |
$15.57
|
| Rate for Payer: United Healthcare Commercial |
$23.36
|
| Rate for Payer: United Healthcare Medicare |
$15.57
|
| Rate for Payer: WINHealth Partners Commercial |
$26.31
|
| Rate for Payer: Wise Provider Network Commercial |
$25.51
|
|
|
SUT CORZA CHROMIC 4-0 PS-2 18"
|
Facility
|
IP
|
$16.21
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$16.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.56
|
| Rate for Payer: Altius Commercial |
$15.56
|
| Rate for Payer: Beech Street Commercial |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.31
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.72
|
| Rate for Payer: Cigna of WY Commercial |
$15.89
|
| Rate for Payer: Entrust Commercial |
$15.40
|
| Rate for Payer: First Choice Health Commercial |
$15.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.70
|
| Rate for Payer: HealthUtah PPO |
$16.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.72
|
| Rate for Payer: Multiplan Medicare/VA |
$10.16
|
| Rate for Payer: One Health Plan of WY PPO |
$15.89
|
| Rate for Payer: PacificSource Commercial |
$14.59
|
| Rate for Payer: PHCS PPO |
$15.89
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$10.70
|
| Rate for Payer: United Healthcare Commercial |
$14.10
|
| Rate for Payer: United Healthcare Medicare |
$10.70
|
| Rate for Payer: WINHealth Partners Commercial |
$15.40
|
| Rate for Payer: Wise Provider Network Commercial |
$15.40
|
|
|
SUT CORZA CHROMIC 4-0 PS-2 18"
|
Facility
|
OP
|
$16.21
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$16.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.89
|
| Rate for Payer: Aetna of WY Medicare |
$10.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.56
|
| Rate for Payer: Altius Commercial |
$15.56
|
| Rate for Payer: Beech Street Commercial |
$15.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.31
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.72
|
| Rate for Payer: Cigna of WY Commercial |
$15.89
|
| Rate for Payer: Entrust Commercial |
$15.40
|
| Rate for Payer: First Choice Health Commercial |
$15.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.40
|
| Rate for Payer: HealthUtah PPO |
$16.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.72
|
| Rate for Payer: Multiplan Medicare/VA |
$8.93
|
| Rate for Payer: One Health Plan of WY PPO |
$15.89
|
| Rate for Payer: PacificSource Commercial |
$14.59
|
| Rate for Payer: PHCS PPO |
$15.89
|
| Rate for Payer: Three Rivers PPO |
$12.16
|
| Rate for Payer: TriWest Veterans Administration |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$14.10
|
| Rate for Payer: United Healthcare Medicare |
$9.40
|
| Rate for Payer: WINHealth Partners Commercial |
$15.89
|
| Rate for Payer: Wise Provider Network Commercial |
$15.40
|
|
