|
SUT FIBERLOOP #2 CURV AR-7234C
|
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 FIBERTAPE 2MM AR-7237-7
|
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 FIBERTAPE 2MM AR-7237-7
|
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 FIBERTAPE CERCLAGE AR-7268
|
Facility
|
OP
|
$1,941.80
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.93 |
| Max. Negotiated Rate |
$1,941.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,902.96
|
| Rate for Payer: Aetna of WY Medicare |
$1,281.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,864.13
|
| Rate for Payer: Altius Commercial |
$1,864.13
|
| Rate for Payer: Beech Street Commercial |
$1,902.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,594.22
|
| Rate for Payer: Cash Price |
$1,359.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,883.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,902.96
|
| Rate for Payer: Entrust Commercial |
$1,844.71
|
| Rate for Payer: First Choice Health Commercial |
$1,844.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,844.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,126.24
|
| Rate for Payer: HealthUtah PPO |
$1,941.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,883.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,069.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1,902.96
|
| Rate for Payer: PacificSource Commercial |
$1,747.62
|
| Rate for Payer: PHCS PPO |
$1,902.96
|
| Rate for Payer: Three Rivers PPO |
$1,456.35
|
| Rate for Payer: TriWest Veterans Administration |
$1,126.24
|
| Rate for Payer: United Healthcare Commercial |
$1,689.37
|
| Rate for Payer: United Healthcare Medicare |
$1,126.24
|
| Rate for Payer: WINHealth Partners Commercial |
$1,902.96
|
| Rate for Payer: Wise Provider Network Commercial |
$1,844.71
|
|
|
SUT FIBERTAPE CERCLAGE AR-7268
|
Facility
|
IP
|
$1,941.80
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.51 |
| Max. Negotiated Rate |
$1,941.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,902.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,864.13
|
| Rate for Payer: Altius Commercial |
$1,864.13
|
| Rate for Payer: Beech Street Commercial |
$1,902.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,594.22
|
| Rate for Payer: Cash Price |
$1,359.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,883.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,902.96
|
| Rate for Payer: Entrust Commercial |
$1,844.71
|
| Rate for Payer: First Choice Health Commercial |
$1,844.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,844.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,281.59
|
| Rate for Payer: HealthUtah PPO |
$1,941.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,883.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1,217.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,902.96
|
| Rate for Payer: PacificSource Commercial |
$1,747.62
|
| Rate for Payer: PHCS PPO |
$1,902.96
|
| Rate for Payer: Three Rivers PPO |
$1,456.35
|
| Rate for Payer: TriWest Veterans Administration |
$1,281.59
|
| Rate for Payer: United Healthcare Commercial |
$1,689.37
|
| Rate for Payer: United Healthcare Medicare |
$1,281.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,844.71
|
| Rate for Payer: Wise Provider Network Commercial |
$1,844.71
|
|
|
SUT FIBERWIRE 0 38" AR-7250
|
Facility
|
OP
|
$89.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.15
|
| Rate for Payer: Aetna of WY Medicare |
$59.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.35
|
| Rate for Payer: Altius Commercial |
$86.35
|
| Rate for Payer: Beech Street Commercial |
$88.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.85
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.25
|
| Rate for Payer: Cigna of WY Commercial |
$88.15
|
| Rate for Payer: Entrust Commercial |
$85.45
|
| Rate for Payer: First Choice Health Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.17
|
| Rate for Payer: HealthUtah PPO |
$89.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.25
|
| Rate for Payer: Multiplan Medicare/VA |
$49.56
|
| Rate for Payer: One Health Plan of WY PPO |
$88.15
|
| Rate for Payer: PacificSource Commercial |
$80.96
|
| Rate for Payer: PHCS PPO |
$88.15
|
| Rate for Payer: Three Rivers PPO |
$67.46
|
| Rate for Payer: TriWest Veterans Administration |
$52.17
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$52.17
|
| Rate for Payer: WINHealth Partners Commercial |
$88.15
|
| Rate for Payer: Wise Provider Network Commercial |
$85.45
|
|
|
SUT FIBERWIRE 0 38" AR-7250
|
Facility
|
IP
|
$89.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.35
|
| Rate for Payer: Altius Commercial |
$86.35
|
| Rate for Payer: Beech Street Commercial |
$88.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.85
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.25
|
| Rate for Payer: Cigna of WY Commercial |
$88.15
|
| Rate for Payer: Entrust Commercial |
$85.45
|
| Rate for Payer: First Choice Health Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.37
|
| Rate for Payer: HealthUtah PPO |
$89.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.25
|
| Rate for Payer: Multiplan Medicare/VA |
$56.40
|
| Rate for Payer: One Health Plan of WY PPO |
$88.15
|
| Rate for Payer: PacificSource Commercial |
$80.96
|
| Rate for Payer: PHCS PPO |
$88.15
|
| Rate for Payer: Three Rivers PPO |
$67.46
|
| Rate for Payer: TriWest Veterans Administration |
$59.37
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$59.37
|
| Rate for Payer: WINHealth Partners Commercial |
$85.45
|
| Rate for Payer: Wise Provider Network Commercial |
$85.45
|
|
|
SUT FIBERWIRE 2-0 18" AR-7220
|
Facility
|
IP
|
$89.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.35
|
| Rate for Payer: Altius Commercial |
$86.35
|
| Rate for Payer: Beech Street Commercial |
$88.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.85
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.25
|
| Rate for Payer: Cigna of WY Commercial |
$88.15
|
| Rate for Payer: Entrust Commercial |
$85.45
|
| Rate for Payer: First Choice Health Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.37
|
| Rate for Payer: HealthUtah PPO |
$89.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.25
|
| Rate for Payer: Multiplan Medicare/VA |
$56.40
|
| Rate for Payer: One Health Plan of WY PPO |
$88.15
|
| Rate for Payer: PacificSource Commercial |
$80.96
|
| Rate for Payer: PHCS PPO |
$88.15
|
| Rate for Payer: Three Rivers PPO |
$67.46
|
| Rate for Payer: TriWest Veterans Administration |
$59.37
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$59.37
|
| Rate for Payer: WINHealth Partners Commercial |
$85.45
|
| Rate for Payer: Wise Provider Network Commercial |
$85.45
|
|
|
SUT FIBERWIRE 2-0 18" AR-7220
|
Facility
|
OP
|
$89.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.15
|
| Rate for Payer: Aetna of WY Medicare |
$59.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.35
|
| Rate for Payer: Altius Commercial |
$86.35
|
| Rate for Payer: Beech Street Commercial |
$88.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.85
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.25
|
| Rate for Payer: Cigna of WY Commercial |
$88.15
|
| Rate for Payer: Entrust Commercial |
$85.45
|
| Rate for Payer: First Choice Health Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.17
|
| Rate for Payer: HealthUtah PPO |
$89.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.25
|
| Rate for Payer: Multiplan Medicare/VA |
$49.56
|
| Rate for Payer: One Health Plan of WY PPO |
$88.15
|
| Rate for Payer: PacificSource Commercial |
$80.96
|
| Rate for Payer: PHCS PPO |
$88.15
|
| Rate for Payer: Three Rivers PPO |
$67.46
|
| Rate for Payer: TriWest Veterans Administration |
$52.17
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$52.17
|
| Rate for Payer: WINHealth Partners Commercial |
$88.15
|
| Rate for Payer: Wise Provider Network Commercial |
$85.45
|
|
|
SUT FIBERWIRE 2-0 TIE AR-7221
|
Facility
|
IP
|
$52.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.92 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.40
|
| Rate for Payer: Altius Commercial |
$50.40
|
| Rate for Payer: Beech Street Commercial |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.10
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.92
|
| Rate for Payer: Cigna of WY Commercial |
$51.45
|
| Rate for Payer: Entrust Commercial |
$49.88
|
| Rate for Payer: First Choice Health Commercial |
$49.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.65
|
| Rate for Payer: HealthUtah PPO |
$52.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.92
|
| Rate for Payer: Multiplan Medicare/VA |
$32.92
|
| Rate for Payer: One Health Plan of WY PPO |
$51.45
|
| Rate for Payer: PacificSource Commercial |
$47.25
|
| Rate for Payer: PHCS PPO |
$51.45
|
| Rate for Payer: Three Rivers PPO |
$39.38
|
| Rate for Payer: TriWest Veterans Administration |
$34.65
|
| Rate for Payer: United Healthcare Commercial |
$45.68
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
| Rate for Payer: WINHealth Partners Commercial |
$49.88
|
| Rate for Payer: Wise Provider Network Commercial |
$49.88
|
|
|
SUT FIBERWIRE 2-0 TIE AR-7221
|
Facility
|
OP
|
$52.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.45
|
| Rate for Payer: Aetna of WY Medicare |
$34.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.40
|
| Rate for Payer: Altius Commercial |
$50.40
|
| Rate for Payer: Beech Street Commercial |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.10
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.92
|
| Rate for Payer: Cigna of WY Commercial |
$51.45
|
| Rate for Payer: Entrust Commercial |
$49.88
|
| Rate for Payer: First Choice Health Commercial |
$49.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.45
|
| Rate for Payer: HealthUtah PPO |
$52.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.92
|
| Rate for Payer: Multiplan Medicare/VA |
$28.93
|
| Rate for Payer: One Health Plan of WY PPO |
$51.45
|
| Rate for Payer: PacificSource Commercial |
$47.25
|
| Rate for Payer: PHCS PPO |
$51.45
|
| Rate for Payer: Three Rivers PPO |
$39.38
|
| Rate for Payer: TriWest Veterans Administration |
$30.45
|
| Rate for Payer: United Healthcare Commercial |
$45.68
|
| Rate for Payer: United Healthcare Medicare |
$30.45
|
| Rate for Payer: WINHealth Partners Commercial |
$51.45
|
| Rate for Payer: Wise Provider Network Commercial |
$49.88
|
|
|
SUT FIBERWIRE #2 BLUE AR-7200
|
Facility
|
OP
|
$89.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.15
|
| Rate for Payer: Aetna of WY Medicare |
$59.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.35
|
| Rate for Payer: Altius Commercial |
$86.35
|
| Rate for Payer: Beech Street Commercial |
$88.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.85
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.25
|
| Rate for Payer: Cigna of WY Commercial |
$88.15
|
| Rate for Payer: Entrust Commercial |
$85.45
|
| Rate for Payer: First Choice Health Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.17
|
| Rate for Payer: HealthUtah PPO |
$89.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.25
|
| Rate for Payer: Multiplan Medicare/VA |
$49.56
|
| Rate for Payer: One Health Plan of WY PPO |
$88.15
|
| Rate for Payer: PacificSource Commercial |
$80.96
|
| Rate for Payer: PHCS PPO |
$88.15
|
| Rate for Payer: Three Rivers PPO |
$67.46
|
| Rate for Payer: TriWest Veterans Administration |
$52.17
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$52.17
|
| Rate for Payer: WINHealth Partners Commercial |
$88.15
|
| Rate for Payer: Wise Provider Network Commercial |
$85.45
|
|
|
SUT FIBERWIRE #2 BLUE AR-7200
|
Facility
|
IP
|
$89.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.35
|
| Rate for Payer: Altius Commercial |
$86.35
|
| Rate for Payer: Beech Street Commercial |
$88.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.85
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.25
|
| Rate for Payer: Cigna of WY Commercial |
$88.15
|
| Rate for Payer: Entrust Commercial |
$85.45
|
| Rate for Payer: First Choice Health Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.37
|
| Rate for Payer: HealthUtah PPO |
$89.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.25
|
| Rate for Payer: Multiplan Medicare/VA |
$56.40
|
| Rate for Payer: One Health Plan of WY PPO |
$88.15
|
| Rate for Payer: PacificSource Commercial |
$80.96
|
| Rate for Payer: PHCS PPO |
$88.15
|
| Rate for Payer: Three Rivers PPO |
$67.46
|
| Rate for Payer: TriWest Veterans Administration |
$59.37
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$59.37
|
| Rate for Payer: WINHealth Partners Commercial |
$85.45
|
| Rate for Payer: Wise Provider Network Commercial |
$85.45
|
|
|
SUT FIBERWIRE 2 NO NDL AR-7201
|
Facility
|
OP
|
$143.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.84 |
| Max. Negotiated Rate |
$143.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.22
|
| Rate for Payer: Aetna of WY Medicare |
$94.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.36
|
| Rate for Payer: Altius Commercial |
$137.36
|
| Rate for Payer: Beech Street Commercial |
$140.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.47
|
| Rate for Payer: Cash Price |
$100.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.79
|
| Rate for Payer: Cigna of WY Commercial |
$140.22
|
| Rate for Payer: Entrust Commercial |
$135.93
|
| Rate for Payer: First Choice Health Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.99
|
| Rate for Payer: HealthUtah PPO |
$143.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.79
|
| Rate for Payer: Multiplan Medicare/VA |
$78.84
|
| Rate for Payer: One Health Plan of WY PPO |
$140.22
|
| Rate for Payer: PacificSource Commercial |
$128.77
|
| Rate for Payer: PHCS PPO |
$140.22
|
| Rate for Payer: Three Rivers PPO |
$107.31
|
| Rate for Payer: TriWest Veterans Administration |
$82.99
|
| Rate for Payer: United Healthcare Commercial |
$124.48
|
| Rate for Payer: United Healthcare Medicare |
$82.99
|
| Rate for Payer: WINHealth Partners Commercial |
$140.22
|
| Rate for Payer: Wise Provider Network Commercial |
$135.93
|
|
|
SUT FIBERWIRE 2 NO NDL AR-7201
|
Facility
|
IP
|
$143.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.71 |
| Max. Negotiated Rate |
$143.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.36
|
| Rate for Payer: Altius Commercial |
$137.36
|
| Rate for Payer: Beech Street Commercial |
$140.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.47
|
| Rate for Payer: Cash Price |
$100.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.79
|
| Rate for Payer: Cigna of WY Commercial |
$140.22
|
| Rate for Payer: Entrust Commercial |
$135.93
|
| Rate for Payer: First Choice Health Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.43
|
| Rate for Payer: HealthUtah PPO |
$143.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.79
|
| Rate for Payer: Multiplan Medicare/VA |
$89.71
|
| Rate for Payer: One Health Plan of WY PPO |
$140.22
|
| Rate for Payer: PacificSource Commercial |
$128.77
|
| Rate for Payer: PHCS PPO |
$140.22
|
| Rate for Payer: Three Rivers PPO |
$107.31
|
| Rate for Payer: TriWest Veterans Administration |
$94.43
|
| Rate for Payer: United Healthcare Commercial |
$124.48
|
| Rate for Payer: United Healthcare Medicare |
$94.43
|
| Rate for Payer: WINHealth Partners Commercial |
$135.93
|
| Rate for Payer: Wise Provider Network Commercial |
$135.93
|
|
|
SUT FIBERWIRE 3-0 18"
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$73.92
|
| Rate for Payer: Altius Commercial |
$73.92
|
| Rate for Payer: Beech Street Commercial |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.22
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.69
|
| Rate for Payer: Cigna of WY Commercial |
$75.46
|
| Rate for Payer: Entrust Commercial |
$73.15
|
| Rate for Payer: First Choice Health Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.82
|
| Rate for Payer: HealthUtah PPO |
$77.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.69
|
| Rate for Payer: Multiplan Medicare/VA |
$48.28
|
| Rate for Payer: One Health Plan of WY PPO |
$75.46
|
| Rate for Payer: PacificSource Commercial |
$69.30
|
| Rate for Payer: PHCS PPO |
$75.46
|
| Rate for Payer: Three Rivers PPO |
$57.75
|
| Rate for Payer: TriWest Veterans Administration |
$50.82
|
| Rate for Payer: United Healthcare Commercial |
$66.99
|
| Rate for Payer: United Healthcare Medicare |
$50.82
|
| Rate for Payer: WINHealth Partners Commercial |
$73.15
|
| Rate for Payer: Wise Provider Network Commercial |
$73.15
|
|
|
SUT FIBERWIRE 3-0 18"
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.46
|
| Rate for Payer: Aetna of WY Medicare |
$50.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$73.92
|
| Rate for Payer: Altius Commercial |
$73.92
|
| Rate for Payer: Beech Street Commercial |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$63.22
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.69
|
| Rate for Payer: Cigna of WY Commercial |
$75.46
|
| Rate for Payer: Entrust Commercial |
$73.15
|
| Rate for Payer: First Choice Health Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.66
|
| Rate for Payer: HealthUtah PPO |
$77.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.69
|
| Rate for Payer: Multiplan Medicare/VA |
$42.43
|
| Rate for Payer: One Health Plan of WY PPO |
$75.46
|
| Rate for Payer: PacificSource Commercial |
$69.30
|
| Rate for Payer: PHCS PPO |
$75.46
|
| Rate for Payer: Three Rivers PPO |
$57.75
|
| Rate for Payer: TriWest Veterans Administration |
$44.66
|
| Rate for Payer: United Healthcare Commercial |
$66.99
|
| Rate for Payer: United Healthcare Medicare |
$44.66
|
| Rate for Payer: WINHealth Partners Commercial |
$75.46
|
| Rate for Payer: Wise Provider Network Commercial |
$73.15
|
|
|
SUT FIBERWIRE 4-0 18" AR-7228
|
Facility
|
IP
|
$89.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.35
|
| Rate for Payer: Altius Commercial |
$86.35
|
| Rate for Payer: Beech Street Commercial |
$88.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.85
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.25
|
| Rate for Payer: Cigna of WY Commercial |
$88.15
|
| Rate for Payer: Entrust Commercial |
$85.45
|
| Rate for Payer: First Choice Health Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.37
|
| Rate for Payer: HealthUtah PPO |
$89.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.25
|
| Rate for Payer: Multiplan Medicare/VA |
$56.40
|
| Rate for Payer: One Health Plan of WY PPO |
$88.15
|
| Rate for Payer: PacificSource Commercial |
$80.96
|
| Rate for Payer: PHCS PPO |
$88.15
|
| Rate for Payer: Three Rivers PPO |
$67.46
|
| Rate for Payer: TriWest Veterans Administration |
$59.37
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$59.37
|
| Rate for Payer: WINHealth Partners Commercial |
$85.45
|
| Rate for Payer: Wise Provider Network Commercial |
$85.45
|
|
|
SUT FIBERWIRE 4-0 18" AR-7228
|
Facility
|
OP
|
$89.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$89.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.15
|
| Rate for Payer: Aetna of WY Medicare |
$59.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$86.35
|
| Rate for Payer: Altius Commercial |
$86.35
|
| Rate for Payer: Beech Street Commercial |
$88.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.85
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.25
|
| Rate for Payer: Cigna of WY Commercial |
$88.15
|
| Rate for Payer: Entrust Commercial |
$85.45
|
| Rate for Payer: First Choice Health Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.17
|
| Rate for Payer: HealthUtah PPO |
$89.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.25
|
| Rate for Payer: Multiplan Medicare/VA |
$49.56
|
| Rate for Payer: One Health Plan of WY PPO |
$88.15
|
| Rate for Payer: PacificSource Commercial |
$80.96
|
| Rate for Payer: PHCS PPO |
$88.15
|
| Rate for Payer: Three Rivers PPO |
$67.46
|
| Rate for Payer: TriWest Veterans Administration |
$52.17
|
| Rate for Payer: United Healthcare Commercial |
$78.26
|
| Rate for Payer: United Healthcare Medicare |
$52.17
|
| Rate for Payer: WINHealth Partners Commercial |
$88.15
|
| Rate for Payer: Wise Provider Network Commercial |
$85.45
|
|
|
SUT FIBERWIRE#5 38" AR-7211
|
Facility
|
OP
|
$101.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.93 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.47
|
| Rate for Payer: Aetna of WY Medicare |
$66.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.44
|
| Rate for Payer: Altius Commercial |
$97.44
|
| Rate for Payer: Beech Street Commercial |
$99.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.33
|
| Rate for Payer: Cash Price |
$71.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.46
|
| Rate for Payer: Cigna of WY Commercial |
$99.47
|
| Rate for Payer: Entrust Commercial |
$96.42
|
| Rate for Payer: First Choice Health Commercial |
$96.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.87
|
| Rate for Payer: HealthUtah PPO |
$101.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.46
|
| Rate for Payer: Multiplan Medicare/VA |
$55.93
|
| Rate for Payer: One Health Plan of WY PPO |
$99.47
|
| Rate for Payer: PacificSource Commercial |
$91.35
|
| Rate for Payer: PHCS PPO |
$99.47
|
| Rate for Payer: Three Rivers PPO |
$76.12
|
| Rate for Payer: TriWest Veterans Administration |
$58.87
|
| Rate for Payer: United Healthcare Commercial |
$88.30
|
| Rate for Payer: United Healthcare Medicare |
$58.87
|
| Rate for Payer: WINHealth Partners Commercial |
$99.47
|
| Rate for Payer: Wise Provider Network Commercial |
$96.42
|
|
|
SUT FIBERWIRE#5 38" AR-7211
|
Facility
|
IP
|
$101.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.44
|
| Rate for Payer: Altius Commercial |
$97.44
|
| Rate for Payer: Beech Street Commercial |
$99.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.33
|
| Rate for Payer: Cash Price |
$71.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.46
|
| Rate for Payer: Cigna of WY Commercial |
$99.47
|
| Rate for Payer: Entrust Commercial |
$96.42
|
| Rate for Payer: First Choice Health Commercial |
$96.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.99
|
| Rate for Payer: HealthUtah PPO |
$101.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.46
|
| Rate for Payer: Multiplan Medicare/VA |
$63.64
|
| Rate for Payer: One Health Plan of WY PPO |
$99.47
|
| Rate for Payer: PacificSource Commercial |
$91.35
|
| Rate for Payer: PHCS PPO |
$99.47
|
| Rate for Payer: Three Rivers PPO |
$76.12
|
| Rate for Payer: TriWest Veterans Administration |
$66.99
|
| Rate for Payer: United Healthcare Commercial |
$88.30
|
| Rate for Payer: United Healthcare Medicare |
$66.99
|
| Rate for Payer: WINHealth Partners Commercial |
$96.42
|
| Rate for Payer: Wise Provider Network Commercial |
$96.42
|
|
|
SUT HD SCORPION NEEDLE
|
Facility
|
IP
|
$682.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$427.93 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$655.20
|
| Rate for Payer: Altius Commercial |
$655.20
|
| Rate for Payer: Beech Street Commercial |
$668.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$560.33
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.02
|
| Rate for Payer: Cigna of WY Commercial |
$668.85
|
| Rate for Payer: Entrust Commercial |
$648.38
|
| Rate for Payer: First Choice Health Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.45
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$427.93
|
| Rate for Payer: One Health Plan of WY PPO |
$668.85
|
| Rate for Payer: PacificSource Commercial |
$614.25
|
| Rate for Payer: PHCS PPO |
$668.85
|
| Rate for Payer: Three Rivers PPO |
$511.88
|
| Rate for Payer: TriWest Veterans Administration |
$450.45
|
| Rate for Payer: United Healthcare Commercial |
$593.78
|
| Rate for Payer: United Healthcare Medicare |
$450.45
|
| Rate for Payer: WINHealth Partners Commercial |
$648.38
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
SUT HD SCORPION NEEDLE
|
Facility
|
OP
|
$682.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.06 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$450.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$655.20
|
| Rate for Payer: Altius Commercial |
$655.20
|
| Rate for Payer: Beech Street Commercial |
$668.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$560.33
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.02
|
| Rate for Payer: Cigna of WY Commercial |
$668.85
|
| Rate for Payer: Entrust Commercial |
$648.38
|
| Rate for Payer: First Choice Health Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$395.85
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$376.06
|
| Rate for Payer: One Health Plan of WY PPO |
$668.85
|
| Rate for Payer: PacificSource Commercial |
$614.25
|
| Rate for Payer: PHCS PPO |
$668.85
|
| Rate for Payer: Three Rivers PPO |
$511.88
|
| Rate for Payer: TriWest Veterans Administration |
$395.85
|
| Rate for Payer: United Healthcare Commercial |
$593.78
|
| Rate for Payer: United Healthcare Medicare |
$395.85
|
| Rate for Payer: WINHealth Partners Commercial |
$668.85
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
SUT LASSO 25 TC LEFT 6068-25TL
|
Facility
|
OP
|
$654.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$654.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$641.00
|
| Rate for Payer: Aetna of WY Medicare |
$431.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$627.92
|
| Rate for Payer: Altius Commercial |
$627.92
|
| Rate for Payer: Beech Street Commercial |
$641.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$537.00
|
| Rate for Payer: Cash Price |
$457.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$634.46
|
| Rate for Payer: Cigna of WY Commercial |
$641.00
|
| Rate for Payer: Entrust Commercial |
$621.38
|
| Rate for Payer: First Choice Health Commercial |
$621.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$621.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.37
|
| Rate for Payer: HealthUtah PPO |
$654.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$634.46
|
| Rate for Payer: Multiplan Medicare/VA |
$360.40
|
| Rate for Payer: One Health Plan of WY PPO |
$641.00
|
| Rate for Payer: PacificSource Commercial |
$588.67
|
| Rate for Payer: PHCS PPO |
$641.00
|
| Rate for Payer: Three Rivers PPO |
$490.56
|
| Rate for Payer: TriWest Veterans Administration |
$379.37
|
| Rate for Payer: United Healthcare Commercial |
$569.05
|
| Rate for Payer: United Healthcare Medicare |
$379.37
|
| Rate for Payer: WINHealth Partners Commercial |
$641.00
|
| Rate for Payer: Wise Provider Network Commercial |
$621.38
|
|
|
SUT LASSO 25 TC LEFT 6068-25TL
|
Facility
|
IP
|
$654.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.11 |
| Max. Negotiated Rate |
$654.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$641.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$627.92
|
| Rate for Payer: Altius Commercial |
$627.92
|
| Rate for Payer: Beech Street Commercial |
$641.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$537.00
|
| Rate for Payer: Cash Price |
$457.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$634.46
|
| Rate for Payer: Cigna of WY Commercial |
$641.00
|
| Rate for Payer: Entrust Commercial |
$621.38
|
| Rate for Payer: First Choice Health Commercial |
$621.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$621.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.69
|
| Rate for Payer: HealthUtah PPO |
$654.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$634.46
|
| Rate for Payer: Multiplan Medicare/VA |
$410.11
|
| Rate for Payer: One Health Plan of WY PPO |
$641.00
|
| Rate for Payer: PacificSource Commercial |
$588.67
|
| Rate for Payer: PHCS PPO |
$641.00
|
| Rate for Payer: Three Rivers PPO |
$490.56
|
| Rate for Payer: TriWest Veterans Administration |
$431.69
|
| Rate for Payer: United Healthcare Commercial |
$569.05
|
| Rate for Payer: United Healthcare Medicare |
$431.69
|
| Rate for Payer: WINHealth Partners Commercial |
$621.38
|
| Rate for Payer: Wise Provider Network Commercial |
$621.38
|
|
