|
SUT ET SILK 3-0 SH K832H
|
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 |
$2.28
|
| 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
|
|
|
SUT ET SILK 3-0 SH K832H
|
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 |
$2.28
|
| 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 VICRYL 0 CTX J978H
|
Facility
|
OP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Aetna of WY Medicare |
$3.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.76
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4.66
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUT ET VICRYL 0 CTX J978H
|
Facility
|
IP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.14
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.98
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.14
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4.51
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUT ET VICRYL 0 UR-5 J376H
|
Facility
|
OP
|
$5.39
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.28
|
| Rate for Payer: Aetna of WY Medicare |
$3.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.17
|
| Rate for Payer: Altius Commercial |
$5.17
|
| Rate for Payer: Beech Street Commercial |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.43
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.23
|
| Rate for Payer: Cigna of WY Commercial |
$5.28
|
| Rate for Payer: Entrust Commercial |
$5.12
|
| Rate for Payer: First Choice Health Commercial |
$5.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.13
|
| Rate for Payer: HealthUtah PPO |
$5.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.23
|
| Rate for Payer: Multiplan Medicare/VA |
$2.97
|
| Rate for Payer: One Health Plan of WY PPO |
$5.28
|
| Rate for Payer: PacificSource Commercial |
$4.85
|
| Rate for Payer: PHCS PPO |
$5.28
|
| Rate for Payer: Three Rivers PPO |
$4.04
|
| Rate for Payer: TriWest Veterans Administration |
$3.13
|
| Rate for Payer: United Healthcare Commercial |
$4.69
|
| Rate for Payer: United Healthcare Medicare |
$3.13
|
| Rate for Payer: WINHealth Partners Commercial |
$5.28
|
| Rate for Payer: Wise Provider Network Commercial |
$5.12
|
|
|
SUT ET VICRYL 0 UR-5 J376H
|
Facility
|
IP
|
$5.39
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.17
|
| Rate for Payer: Altius Commercial |
$5.17
|
| Rate for Payer: Beech Street Commercial |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.43
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.23
|
| Rate for Payer: Cigna of WY Commercial |
$5.28
|
| Rate for Payer: Entrust Commercial |
$5.12
|
| Rate for Payer: First Choice Health Commercial |
$5.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.56
|
| Rate for Payer: HealthUtah PPO |
$5.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.23
|
| Rate for Payer: Multiplan Medicare/VA |
$3.38
|
| Rate for Payer: One Health Plan of WY PPO |
$5.28
|
| Rate for Payer: PacificSource Commercial |
$4.85
|
| Rate for Payer: PHCS PPO |
$5.28
|
| Rate for Payer: Three Rivers PPO |
$4.04
|
| Rate for Payer: TriWest Veterans Administration |
$3.56
|
| Rate for Payer: United Healthcare Commercial |
$4.69
|
| Rate for Payer: United Healthcare Medicare |
$3.56
|
| Rate for Payer: WINHealth Partners Commercial |
$5.12
|
| Rate for Payer: Wise Provider Network Commercial |
$5.12
|
|
|
SUT ET VICRYL 1 CR OS-8 J757T
|
Facility
|
OP
|
$19.02
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$19.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.64
|
| Rate for Payer: Aetna of WY Medicare |
$12.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.26
|
| Rate for Payer: Altius Commercial |
$18.26
|
| Rate for Payer: Beech Street Commercial |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.62
|
| Rate for Payer: Cash Price |
$13.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.45
|
| Rate for Payer: Cigna of WY Commercial |
$18.64
|
| Rate for Payer: Entrust Commercial |
$18.07
|
| Rate for Payer: First Choice Health Commercial |
$18.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.03
|
| Rate for Payer: HealthUtah PPO |
$19.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.45
|
| Rate for Payer: Multiplan Medicare/VA |
$10.48
|
| Rate for Payer: One Health Plan of WY PPO |
$18.64
|
| Rate for Payer: PacificSource Commercial |
$17.12
|
| Rate for Payer: PHCS PPO |
$18.64
|
| Rate for Payer: Three Rivers PPO |
$14.26
|
| Rate for Payer: TriWest Veterans Administration |
$11.03
|
| Rate for Payer: United Healthcare Commercial |
$16.55
|
| Rate for Payer: United Healthcare Medicare |
$11.03
|
| Rate for Payer: WINHealth Partners Commercial |
$18.64
|
| Rate for Payer: Wise Provider Network Commercial |
$18.07
|
|
|
SUT ET VICRYL 1 CR OS-8 J757T
|
Facility
|
IP
|
$19.02
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$19.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.26
|
| Rate for Payer: Altius Commercial |
$18.26
|
| Rate for Payer: Beech Street Commercial |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.62
|
| Rate for Payer: Cash Price |
$13.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.45
|
| Rate for Payer: Cigna of WY Commercial |
$18.64
|
| Rate for Payer: Entrust Commercial |
$18.07
|
| Rate for Payer: First Choice Health Commercial |
$18.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.55
|
| Rate for Payer: HealthUtah PPO |
$19.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.45
|
| Rate for Payer: Multiplan Medicare/VA |
$11.93
|
| Rate for Payer: One Health Plan of WY PPO |
$18.64
|
| Rate for Payer: PacificSource Commercial |
$17.12
|
| Rate for Payer: PHCS PPO |
$18.64
|
| Rate for Payer: Three Rivers PPO |
$14.26
|
| Rate for Payer: TriWest Veterans Administration |
$12.55
|
| Rate for Payer: United Healthcare Commercial |
$16.55
|
| Rate for Payer: United Healthcare Medicare |
$12.55
|
| Rate for Payer: WINHealth Partners Commercial |
$18.07
|
| Rate for Payer: Wise Provider Network Commercial |
$18.07
|
|
|
SUT ET VICRYL 3-0CT VCP956H
|
Facility
|
IP
|
$4.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.78
|
| Rate for Payer: Altius Commercial |
$4.78
|
| Rate for Payer: Beech Street Commercial |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.83
|
| Rate for Payer: Cigna of WY Commercial |
$4.88
|
| Rate for Payer: Entrust Commercial |
$4.73
|
| Rate for Payer: First Choice Health Commercial |
$4.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.29
|
| Rate for Payer: HealthUtah PPO |
$4.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.83
|
| Rate for Payer: Multiplan Medicare/VA |
$3.12
|
| Rate for Payer: One Health Plan of WY PPO |
$4.88
|
| Rate for Payer: PacificSource Commercial |
$4.48
|
| Rate for Payer: PHCS PPO |
$4.88
|
| Rate for Payer: Three Rivers PPO |
$3.74
|
| Rate for Payer: TriWest Veterans Administration |
$3.29
|
| Rate for Payer: United Healthcare Commercial |
$4.33
|
| Rate for Payer: United Healthcare Medicare |
$3.29
|
| Rate for Payer: WINHealth Partners Commercial |
$4.73
|
| Rate for Payer: Wise Provider Network Commercial |
$4.73
|
|
|
SUT ET VICRYL 3-0CT VCP956H
|
Facility
|
OP
|
$4.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.88
|
| Rate for Payer: Aetna of WY Medicare |
$3.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.78
|
| Rate for Payer: Altius Commercial |
$4.78
|
| Rate for Payer: Beech Street Commercial |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.83
|
| Rate for Payer: Cigna of WY Commercial |
$4.88
|
| Rate for Payer: Entrust Commercial |
$4.73
|
| Rate for Payer: First Choice Health Commercial |
$4.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.89
|
| Rate for Payer: HealthUtah PPO |
$4.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.83
|
| Rate for Payer: Multiplan Medicare/VA |
$2.74
|
| Rate for Payer: One Health Plan of WY PPO |
$4.88
|
| Rate for Payer: PacificSource Commercial |
$4.48
|
| Rate for Payer: PHCS PPO |
$4.88
|
| Rate for Payer: Three Rivers PPO |
$3.74
|
| Rate for Payer: TriWest Veterans Administration |
$2.89
|
| Rate for Payer: United Healthcare Commercial |
$4.33
|
| Rate for Payer: United Healthcare Medicare |
$2.89
|
| Rate for Payer: WINHealth Partners Commercial |
$4.88
|
| Rate for Payer: Wise Provider Network Commercial |
$4.73
|
|
|
SUT ET VICRYL 3-0 TAPER J774D
|
Facility
|
OP
|
$29.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.30
|
| Rate for Payer: Aetna of WY Medicare |
$19.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.70
|
| Rate for Payer: Altius Commercial |
$28.70
|
| Rate for Payer: Beech Street Commercial |
$29.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.55
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.00
|
| Rate for Payer: Cigna of WY Commercial |
$29.30
|
| Rate for Payer: Entrust Commercial |
$28.40
|
| Rate for Payer: First Choice Health Commercial |
$28.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.34
|
| Rate for Payer: HealthUtah PPO |
$29.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.00
|
| Rate for Payer: Multiplan Medicare/VA |
$16.47
|
| Rate for Payer: One Health Plan of WY PPO |
$29.30
|
| Rate for Payer: PacificSource Commercial |
$26.91
|
| Rate for Payer: PHCS PPO |
$29.30
|
| Rate for Payer: Three Rivers PPO |
$22.42
|
| Rate for Payer: TriWest Veterans Administration |
$17.34
|
| Rate for Payer: United Healthcare Commercial |
$26.01
|
| Rate for Payer: United Healthcare Medicare |
$17.34
|
| Rate for Payer: WINHealth Partners Commercial |
$29.30
|
| Rate for Payer: Wise Provider Network Commercial |
$28.40
|
|
|
SUT ET VICRYL 3-0 TAPER J774D
|
Facility
|
IP
|
$29.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.70
|
| Rate for Payer: Altius Commercial |
$28.70
|
| Rate for Payer: Beech Street Commercial |
$29.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.55
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.00
|
| Rate for Payer: Cigna of WY Commercial |
$29.30
|
| Rate for Payer: Entrust Commercial |
$28.40
|
| Rate for Payer: First Choice Health Commercial |
$28.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.73
|
| Rate for Payer: HealthUtah PPO |
$29.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.00
|
| Rate for Payer: Multiplan Medicare/VA |
$18.75
|
| Rate for Payer: One Health Plan of WY PPO |
$29.30
|
| Rate for Payer: PacificSource Commercial |
$26.91
|
| Rate for Payer: PHCS PPO |
$29.30
|
| Rate for Payer: Three Rivers PPO |
$22.42
|
| Rate for Payer: TriWest Veterans Administration |
$19.73
|
| Rate for Payer: United Healthcare Commercial |
$26.01
|
| Rate for Payer: United Healthcare Medicare |
$19.73
|
| Rate for Payer: WINHealth Partners Commercial |
$28.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.40
|
|
|
SUT ET VICRYL 5-0 P-3 J493G
|
Facility
|
IP
|
$12.10
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.62
|
| Rate for Payer: Altius Commercial |
$11.62
|
| Rate for Payer: Beech Street Commercial |
$11.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.93
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.74
|
| Rate for Payer: Cigna of WY Commercial |
$11.86
|
| Rate for Payer: Entrust Commercial |
$11.50
|
| Rate for Payer: First Choice Health Commercial |
$11.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.99
|
| Rate for Payer: HealthUtah PPO |
$12.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.74
|
| Rate for Payer: Multiplan Medicare/VA |
$7.59
|
| Rate for Payer: One Health Plan of WY PPO |
$11.86
|
| Rate for Payer: PacificSource Commercial |
$10.89
|
| Rate for Payer: PHCS PPO |
$11.86
|
| Rate for Payer: Three Rivers PPO |
$9.08
|
| Rate for Payer: TriWest Veterans Administration |
$7.99
|
| Rate for Payer: United Healthcare Commercial |
$10.53
|
| Rate for Payer: United Healthcare Medicare |
$7.99
|
| Rate for Payer: WINHealth Partners Commercial |
$11.50
|
| Rate for Payer: Wise Provider Network Commercial |
$11.50
|
|
|
SUT ET VICRYL 5-0 P-3 J493G
|
Facility
|
OP
|
$12.10
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.86
|
| Rate for Payer: Aetna of WY Medicare |
$7.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.62
|
| Rate for Payer: Altius Commercial |
$11.62
|
| Rate for Payer: Beech Street Commercial |
$11.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.93
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.74
|
| Rate for Payer: Cigna of WY Commercial |
$11.86
|
| Rate for Payer: Entrust Commercial |
$11.50
|
| Rate for Payer: First Choice Health Commercial |
$11.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.02
|
| Rate for Payer: HealthUtah PPO |
$12.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.74
|
| Rate for Payer: Multiplan Medicare/VA |
$6.67
|
| Rate for Payer: One Health Plan of WY PPO |
$11.86
|
| Rate for Payer: PacificSource Commercial |
$10.89
|
| Rate for Payer: PHCS PPO |
$11.86
|
| Rate for Payer: Three Rivers PPO |
$9.08
|
| Rate for Payer: TriWest Veterans Administration |
$7.02
|
| Rate for Payer: United Healthcare Commercial |
$10.53
|
| Rate for Payer: United Healthcare Medicare |
$7.02
|
| Rate for Payer: WINHealth Partners Commercial |
$11.86
|
| Rate for Payer: Wise Provider Network Commercial |
$11.50
|
|
|
SUT ET VICRYL 6-0 PS-6 J510G
|
Facility
|
OP
|
$13.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.04
|
| Rate for Payer: Aetna of WY Medicare |
$8.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.78
|
| Rate for Payer: Altius Commercial |
$12.78
|
| Rate for Payer: Beech Street Commercial |
$13.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.93
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.91
|
| Rate for Payer: Cigna of WY Commercial |
$13.04
|
| Rate for Payer: Entrust Commercial |
$12.64
|
| Rate for Payer: First Choice Health Commercial |
$12.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.72
|
| Rate for Payer: HealthUtah PPO |
$13.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.91
|
| Rate for Payer: Multiplan Medicare/VA |
$7.33
|
| Rate for Payer: One Health Plan of WY PPO |
$13.04
|
| Rate for Payer: PacificSource Commercial |
$11.98
|
| Rate for Payer: PHCS PPO |
$13.04
|
| Rate for Payer: Three Rivers PPO |
$9.98
|
| Rate for Payer: TriWest Veterans Administration |
$7.72
|
| Rate for Payer: United Healthcare Commercial |
$11.58
|
| Rate for Payer: United Healthcare Medicare |
$7.72
|
| Rate for Payer: WINHealth Partners Commercial |
$13.04
|
| Rate for Payer: Wise Provider Network Commercial |
$12.64
|
|
|
SUT ET VICRYL 6-0 PS-6 J510G
|
Facility
|
IP
|
$13.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$13.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.78
|
| Rate for Payer: Altius Commercial |
$12.78
|
| Rate for Payer: Beech Street Commercial |
$13.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.93
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.91
|
| Rate for Payer: Cigna of WY Commercial |
$13.04
|
| Rate for Payer: Entrust Commercial |
$12.64
|
| Rate for Payer: First Choice Health Commercial |
$12.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.78
|
| Rate for Payer: HealthUtah PPO |
$13.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.91
|
| Rate for Payer: Multiplan Medicare/VA |
$8.35
|
| Rate for Payer: One Health Plan of WY PPO |
$13.04
|
| Rate for Payer: PacificSource Commercial |
$11.98
|
| Rate for Payer: PHCS PPO |
$13.04
|
| Rate for Payer: Three Rivers PPO |
$9.98
|
| Rate for Payer: TriWest Veterans Administration |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$11.58
|
| Rate for Payer: United Healthcare Medicare |
$8.78
|
| Rate for Payer: WINHealth Partners Commercial |
$12.64
|
| Rate for Payer: Wise Provider Network Commercial |
$12.64
|
|
|
SUT FIBERLINK #2 AR-7235
|
Facility
|
IP
|
$224.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.97 |
| Max. Negotiated Rate |
$224.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$215.85
|
| Rate for Payer: Altius Commercial |
$215.85
|
| Rate for Payer: Beech Street Commercial |
$220.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.59
|
| Rate for Payer: Cash Price |
$157.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.09
|
| Rate for Payer: Cigna of WY Commercial |
$220.34
|
| Rate for Payer: Entrust Commercial |
$213.60
|
| Rate for Payer: First Choice Health Commercial |
$213.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.39
|
| Rate for Payer: HealthUtah PPO |
$224.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.09
|
| Rate for Payer: Multiplan Medicare/VA |
$140.97
|
| Rate for Payer: One Health Plan of WY PPO |
$220.34
|
| Rate for Payer: PacificSource Commercial |
$202.36
|
| Rate for Payer: PHCS PPO |
$220.34
|
| Rate for Payer: Three Rivers PPO |
$168.63
|
| Rate for Payer: TriWest Veterans Administration |
$148.39
|
| Rate for Payer: United Healthcare Commercial |
$195.61
|
| Rate for Payer: United Healthcare Medicare |
$148.39
|
| Rate for Payer: WINHealth Partners Commercial |
$213.60
|
| Rate for Payer: Wise Provider Network Commercial |
$213.60
|
|
|
SUT FIBERLINK #2 AR-7235
|
Facility
|
OP
|
$224.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.89 |
| Max. Negotiated Rate |
$224.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.34
|
| Rate for Payer: Aetna of WY Medicare |
$148.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$215.85
|
| Rate for Payer: Altius Commercial |
$215.85
|
| Rate for Payer: Beech Street Commercial |
$220.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.59
|
| Rate for Payer: Cash Price |
$157.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.09
|
| Rate for Payer: Cigna of WY Commercial |
$220.34
|
| Rate for Payer: Entrust Commercial |
$213.60
|
| Rate for Payer: First Choice Health Commercial |
$213.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.41
|
| Rate for Payer: HealthUtah PPO |
$224.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.09
|
| Rate for Payer: Multiplan Medicare/VA |
$123.89
|
| Rate for Payer: One Health Plan of WY PPO |
$220.34
|
| Rate for Payer: PacificSource Commercial |
$202.36
|
| Rate for Payer: PHCS PPO |
$220.34
|
| Rate for Payer: Three Rivers PPO |
$168.63
|
| Rate for Payer: TriWest Veterans Administration |
$130.41
|
| Rate for Payer: United Healthcare Commercial |
$195.61
|
| Rate for Payer: United Healthcare Medicare |
$130.41
|
| Rate for Payer: WINHealth Partners Commercial |
$220.34
|
| Rate for Payer: Wise Provider Network Commercial |
$213.60
|
|
|
SUT FIBERLINK AR-7535
|
Facility
|
OP
|
$138.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.34 |
| Max. Negotiated Rate |
$138.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.77
|
| Rate for Payer: Aetna of WY Medicare |
$91.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$133.00
|
| Rate for Payer: Altius Commercial |
$133.00
|
| Rate for Payer: Beech Street Commercial |
$135.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$113.74
|
| Rate for Payer: Cash Price |
$96.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.38
|
| Rate for Payer: Cigna of WY Commercial |
$135.77
|
| Rate for Payer: Entrust Commercial |
$131.61
|
| Rate for Payer: First Choice Health Commercial |
$131.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.35
|
| Rate for Payer: HealthUtah PPO |
$138.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.38
|
| Rate for Payer: Multiplan Medicare/VA |
$76.34
|
| Rate for Payer: One Health Plan of WY PPO |
$135.77
|
| Rate for Payer: PacificSource Commercial |
$124.69
|
| Rate for Payer: PHCS PPO |
$135.77
|
| Rate for Payer: Three Rivers PPO |
$103.90
|
| Rate for Payer: TriWest Veterans Administration |
$80.35
|
| Rate for Payer: United Healthcare Commercial |
$120.53
|
| Rate for Payer: United Healthcare Medicare |
$80.35
|
| Rate for Payer: WINHealth Partners Commercial |
$135.77
|
| Rate for Payer: Wise Provider Network Commercial |
$131.61
|
|
|
SUT FIBERLINK AR-7535
|
Facility
|
IP
|
$138.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$138.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$133.00
|
| Rate for Payer: Altius Commercial |
$133.00
|
| Rate for Payer: Beech Street Commercial |
$135.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$113.74
|
| Rate for Payer: Cash Price |
$96.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.38
|
| Rate for Payer: Cigna of WY Commercial |
$135.77
|
| Rate for Payer: Entrust Commercial |
$131.61
|
| Rate for Payer: First Choice Health Commercial |
$131.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.44
|
| Rate for Payer: HealthUtah PPO |
$138.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.38
|
| Rate for Payer: Multiplan Medicare/VA |
$86.86
|
| Rate for Payer: One Health Plan of WY PPO |
$135.77
|
| Rate for Payer: PacificSource Commercial |
$124.69
|
| Rate for Payer: PHCS PPO |
$135.77
|
| Rate for Payer: Three Rivers PPO |
$103.90
|
| Rate for Payer: TriWest Veterans Administration |
$91.44
|
| Rate for Payer: United Healthcare Commercial |
$120.53
|
| Rate for Payer: United Healthcare Medicare |
$91.44
|
| Rate for Payer: WINHealth Partners Commercial |
$131.61
|
| Rate for Payer: Wise Provider Network Commercial |
$131.61
|
|
|
SUT FIBERLOOP 2-0 AR-7232-02
|
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 FIBERLOOP 2-0 AR-7232-02
|
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 FIBERLOOP #2 20" AR-7234
|
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 FIBERLOOP #2 20" AR-7234
|
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 FIBERLOOP #2 CURV AR-7234C
|
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
|
|
