|
SUT LASSO 25 TC RGHT 6068-25TR
|
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 RGHT 6068-25TR
|
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
|
|
|
SUT LASSO 30 STRAIGHT
|
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 30 STRAIGHT
|
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
|
|
|
SUT LASSO 45 LEFT AR-6068-45L
|
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 45 LEFT AR-6068-45L
|
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
|
|
|
SUT LASSO 45 RIGHT AR-6068-45R
|
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
|
|
|
SUT LASSO 45 RIGHT AR-6068-45R
|
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 MICRO QUICKANCHOR + #3/0 V-4
|
Facility
|
IP
|
$1,862.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.47 |
| Max. Negotiated Rate |
$1,862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,824.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,787.52
|
| Rate for Payer: Altius Commercial |
$1,787.52
|
| Rate for Payer: Beech Street Commercial |
$1,824.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,528.70
|
| Rate for Payer: Cash Price |
$1,303.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,806.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,824.76
|
| Rate for Payer: Entrust Commercial |
$1,768.90
|
| Rate for Payer: First Choice Health Commercial |
$1,768.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,768.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,228.92
|
| Rate for Payer: HealthUtah PPO |
$1,862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,806.14
|
| Rate for Payer: Multiplan Medicare/VA |
$1,167.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,824.76
|
| Rate for Payer: PacificSource Commercial |
$1,675.80
|
| Rate for Payer: PHCS PPO |
$1,824.76
|
| Rate for Payer: Three Rivers PPO |
$1,396.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,228.92
|
| Rate for Payer: United Healthcare Commercial |
$1,619.94
|
| Rate for Payer: United Healthcare Medicare |
$1,228.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1,768.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,768.90
|
|
|
SUT MICRO QUICKANCHOR + #3/0 V-4
|
Facility
|
OP
|
$1,862.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.96 |
| Max. Negotiated Rate |
$1,862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,824.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,228.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,787.52
|
| Rate for Payer: Altius Commercial |
$1,787.52
|
| Rate for Payer: Beech Street Commercial |
$1,824.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,528.70
|
| Rate for Payer: Cash Price |
$1,303.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,806.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,824.76
|
| Rate for Payer: Entrust Commercial |
$1,768.90
|
| Rate for Payer: First Choice Health Commercial |
$1,768.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,768.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,079.96
|
| Rate for Payer: HealthUtah PPO |
$1,862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,806.14
|
| Rate for Payer: Multiplan Medicare/VA |
$1,025.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,824.76
|
| Rate for Payer: PacificSource Commercial |
$1,675.80
|
| Rate for Payer: PHCS PPO |
$1,824.76
|
| Rate for Payer: Three Rivers PPO |
$1,396.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,079.96
|
| Rate for Payer: United Healthcare Commercial |
$1,619.94
|
| Rate for Payer: United Healthcare Medicare |
$1,079.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,824.76
|
| Rate for Payer: Wise Provider Network Commercial |
$1,768.90
|
|
|
SUT MONOCRYL 5-0 P-3 MCP493G
|
Facility
|
IP
|
$15.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.24
|
| Rate for Payer: Altius Commercial |
$15.24
|
| Rate for Payer: Beech Street Commercial |
$15.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.04
|
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.40
|
| Rate for Payer: Cigna of WY Commercial |
$15.56
|
| Rate for Payer: Entrust Commercial |
$15.09
|
| Rate for Payer: First Choice Health Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.48
|
| Rate for Payer: HealthUtah PPO |
$15.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.40
|
| Rate for Payer: Multiplan Medicare/VA |
$9.96
|
| Rate for Payer: One Health Plan of WY PPO |
$15.56
|
| Rate for Payer: PacificSource Commercial |
$14.29
|
| Rate for Payer: PHCS PPO |
$15.56
|
| Rate for Payer: Three Rivers PPO |
$11.91
|
| Rate for Payer: TriWest Veterans Administration |
$10.48
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
| Rate for Payer: United Healthcare Medicare |
$10.48
|
| Rate for Payer: WINHealth Partners Commercial |
$15.09
|
| Rate for Payer: Wise Provider Network Commercial |
$15.09
|
|
|
SUT MONOCRYL 5-0 P-3 MCP493G
|
Facility
|
OP
|
$15.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.56
|
| Rate for Payer: Aetna of WY Medicare |
$10.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.24
|
| Rate for Payer: Altius Commercial |
$15.24
|
| Rate for Payer: Beech Street Commercial |
$15.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.04
|
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.40
|
| Rate for Payer: Cigna of WY Commercial |
$15.56
|
| Rate for Payer: Entrust Commercial |
$15.09
|
| Rate for Payer: First Choice Health Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.21
|
| Rate for Payer: HealthUtah PPO |
$15.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.40
|
| Rate for Payer: Multiplan Medicare/VA |
$8.75
|
| Rate for Payer: One Health Plan of WY PPO |
$15.56
|
| Rate for Payer: PacificSource Commercial |
$14.29
|
| Rate for Payer: PHCS PPO |
$15.56
|
| Rate for Payer: Three Rivers PPO |
$11.91
|
| Rate for Payer: TriWest Veterans Administration |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
| Rate for Payer: United Healthcare Medicare |
$9.21
|
| Rate for Payer: WINHealth Partners Commercial |
$15.56
|
| Rate for Payer: Wise Provider Network Commercial |
$15.09
|
|
|
SUT MONOCRYL PLUS 2-0 SH 27"
|
Facility
|
OP
|
$5.51
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.40
|
| Rate for Payer: Aetna of WY Medicare |
$3.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.29
|
| Rate for Payer: Altius Commercial |
$5.29
|
| Rate for Payer: Beech Street Commercial |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.52
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.34
|
| Rate for Payer: Cigna of WY Commercial |
$5.40
|
| Rate for Payer: Entrust Commercial |
$5.23
|
| Rate for Payer: First Choice Health Commercial |
$5.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.20
|
| Rate for Payer: HealthUtah PPO |
$5.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.34
|
| Rate for Payer: Multiplan Medicare/VA |
$3.04
|
| Rate for Payer: One Health Plan of WY PPO |
$5.40
|
| Rate for Payer: PacificSource Commercial |
$4.96
|
| Rate for Payer: PHCS PPO |
$5.40
|
| Rate for Payer: Three Rivers PPO |
$4.13
|
| Rate for Payer: TriWest Veterans Administration |
$3.20
|
| Rate for Payer: United Healthcare Commercial |
$4.79
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
| Rate for Payer: WINHealth Partners Commercial |
$5.40
|
| Rate for Payer: Wise Provider Network Commercial |
$5.23
|
|
|
SUT MONOCRYL PLUS 2-0 SH 27"
|
Facility
|
IP
|
$5.51
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.29
|
| Rate for Payer: Altius Commercial |
$5.29
|
| Rate for Payer: Beech Street Commercial |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.52
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.34
|
| Rate for Payer: Cigna of WY Commercial |
$5.40
|
| Rate for Payer: Entrust Commercial |
$5.23
|
| Rate for Payer: First Choice Health Commercial |
$5.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.64
|
| Rate for Payer: HealthUtah PPO |
$5.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.34
|
| Rate for Payer: Multiplan Medicare/VA |
$3.45
|
| Rate for Payer: One Health Plan of WY PPO |
$5.40
|
| Rate for Payer: PacificSource Commercial |
$4.96
|
| Rate for Payer: PHCS PPO |
$5.40
|
| Rate for Payer: Three Rivers PPO |
$4.13
|
| Rate for Payer: TriWest Veterans Administration |
$3.64
|
| Rate for Payer: United Healthcare Commercial |
$4.79
|
| Rate for Payer: United Healthcare Medicare |
$3.64
|
| Rate for Payer: WINHealth Partners Commercial |
$5.23
|
| Rate for Payer: Wise Provider Network Commercial |
$5.23
|
|
|
SUT MONOCRYL PLUS 3-0 27" PS-1
|
Facility
|
OP
|
$15.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.56
|
| Rate for Payer: Aetna of WY Medicare |
$10.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.24
|
| Rate for Payer: Altius Commercial |
$15.24
|
| Rate for Payer: Beech Street Commercial |
$15.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.04
|
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.40
|
| Rate for Payer: Cigna of WY Commercial |
$15.56
|
| Rate for Payer: Entrust Commercial |
$15.09
|
| Rate for Payer: First Choice Health Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.21
|
| Rate for Payer: HealthUtah PPO |
$15.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.40
|
| Rate for Payer: Multiplan Medicare/VA |
$8.75
|
| Rate for Payer: One Health Plan of WY PPO |
$15.56
|
| Rate for Payer: PacificSource Commercial |
$14.29
|
| Rate for Payer: PHCS PPO |
$15.56
|
| Rate for Payer: Three Rivers PPO |
$11.91
|
| Rate for Payer: TriWest Veterans Administration |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
| Rate for Payer: United Healthcare Medicare |
$9.21
|
| Rate for Payer: WINHealth Partners Commercial |
$15.56
|
| Rate for Payer: Wise Provider Network Commercial |
$15.09
|
|
|
SUT MONOCRYL PLUS 3-0 27" PS-1
|
Facility
|
IP
|
$15.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.24
|
| Rate for Payer: Altius Commercial |
$15.24
|
| Rate for Payer: Beech Street Commercial |
$15.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.04
|
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.40
|
| Rate for Payer: Cigna of WY Commercial |
$15.56
|
| Rate for Payer: Entrust Commercial |
$15.09
|
| Rate for Payer: First Choice Health Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.48
|
| Rate for Payer: HealthUtah PPO |
$15.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.40
|
| Rate for Payer: Multiplan Medicare/VA |
$9.96
|
| Rate for Payer: One Health Plan of WY PPO |
$15.56
|
| Rate for Payer: PacificSource Commercial |
$14.29
|
| Rate for Payer: PHCS PPO |
$15.56
|
| Rate for Payer: Three Rivers PPO |
$11.91
|
| Rate for Payer: TriWest Veterans Administration |
$10.48
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
| Rate for Payer: United Healthcare Medicare |
$10.48
|
| Rate for Payer: WINHealth Partners Commercial |
$15.09
|
| Rate for Payer: Wise Provider Network Commercial |
$15.09
|
|
|
SUT MONOCRYL PLUS 3-0 SH 27"
|
Facility
|
OP
|
$5.51
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.40
|
| Rate for Payer: Aetna of WY Medicare |
$3.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.29
|
| Rate for Payer: Altius Commercial |
$5.29
|
| Rate for Payer: Beech Street Commercial |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.52
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.34
|
| Rate for Payer: Cigna of WY Commercial |
$5.40
|
| Rate for Payer: Entrust Commercial |
$5.23
|
| Rate for Payer: First Choice Health Commercial |
$5.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.20
|
| Rate for Payer: HealthUtah PPO |
$5.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.34
|
| Rate for Payer: Multiplan Medicare/VA |
$3.04
|
| Rate for Payer: One Health Plan of WY PPO |
$5.40
|
| Rate for Payer: PacificSource Commercial |
$4.96
|
| Rate for Payer: PHCS PPO |
$5.40
|
| Rate for Payer: Three Rivers PPO |
$4.13
|
| Rate for Payer: TriWest Veterans Administration |
$3.20
|
| Rate for Payer: United Healthcare Commercial |
$4.79
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
| Rate for Payer: WINHealth Partners Commercial |
$5.40
|
| Rate for Payer: Wise Provider Network Commercial |
$5.23
|
|
|
SUT MONOCRYL PLUS 3-0 SH 27"
|
Facility
|
IP
|
$5.51
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.29
|
| Rate for Payer: Altius Commercial |
$5.29
|
| Rate for Payer: Beech Street Commercial |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.52
|
| Rate for Payer: Cash Price |
$3.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.34
|
| Rate for Payer: Cigna of WY Commercial |
$5.40
|
| Rate for Payer: Entrust Commercial |
$5.23
|
| Rate for Payer: First Choice Health Commercial |
$5.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.64
|
| Rate for Payer: HealthUtah PPO |
$5.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.34
|
| Rate for Payer: Multiplan Medicare/VA |
$3.45
|
| Rate for Payer: One Health Plan of WY PPO |
$5.40
|
| Rate for Payer: PacificSource Commercial |
$4.96
|
| Rate for Payer: PHCS PPO |
$5.40
|
| Rate for Payer: Three Rivers PPO |
$4.13
|
| Rate for Payer: TriWest Veterans Administration |
$3.64
|
| Rate for Payer: United Healthcare Commercial |
$4.79
|
| Rate for Payer: United Healthcare Medicare |
$3.64
|
| Rate for Payer: WINHealth Partners Commercial |
$5.23
|
| Rate for Payer: Wise Provider Network Commercial |
$5.23
|
|
|
SUT MONOCRYL PLUS 4-0 27" PS-2
|
Facility
|
IP
|
$15.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.52
|
| Rate for Payer: Altius Commercial |
$14.52
|
| Rate for Payer: Beech Street Commercial |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.42
|
| Rate for Payer: Cash Price |
$10.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.68
|
| Rate for Payer: Cigna of WY Commercial |
$14.83
|
| Rate for Payer: Entrust Commercial |
$14.37
|
| Rate for Payer: First Choice Health Commercial |
$14.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.99
|
| Rate for Payer: HealthUtah PPO |
$15.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.68
|
| Rate for Payer: Multiplan Medicare/VA |
$9.49
|
| Rate for Payer: One Health Plan of WY PPO |
$14.83
|
| Rate for Payer: PacificSource Commercial |
$13.62
|
| Rate for Payer: PHCS PPO |
$14.83
|
| Rate for Payer: Three Rivers PPO |
$11.35
|
| Rate for Payer: TriWest Veterans Administration |
$9.99
|
| Rate for Payer: United Healthcare Commercial |
$13.16
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WINHealth Partners Commercial |
$14.37
|
| Rate for Payer: Wise Provider Network Commercial |
$14.37
|
|
|
SUT MONOCRYL PLUS 4-0 27" PS-2
|
Facility
|
OP
|
$15.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.83
|
| Rate for Payer: Aetna of WY Medicare |
$9.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.52
|
| Rate for Payer: Altius Commercial |
$14.52
|
| Rate for Payer: Beech Street Commercial |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.42
|
| Rate for Payer: Cash Price |
$10.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.68
|
| Rate for Payer: Cigna of WY Commercial |
$14.83
|
| Rate for Payer: Entrust Commercial |
$14.37
|
| Rate for Payer: First Choice Health Commercial |
$14.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.78
|
| Rate for Payer: HealthUtah PPO |
$15.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.68
|
| Rate for Payer: Multiplan Medicare/VA |
$8.34
|
| Rate for Payer: One Health Plan of WY PPO |
$14.83
|
| Rate for Payer: PacificSource Commercial |
$13.62
|
| Rate for Payer: PHCS PPO |
$14.83
|
| Rate for Payer: Three Rivers PPO |
$11.35
|
| Rate for Payer: TriWest Veterans Administration |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$13.16
|
| Rate for Payer: United Healthcare Medicare |
$8.78
|
| Rate for Payer: WINHealth Partners Commercial |
$14.83
|
| Rate for Payer: Wise Provider Network Commercial |
$14.37
|
|
|
SUT PDS II 1 CT-1
|
Facility
|
IP
|
$7.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$7.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.48
|
| Rate for Payer: Altius Commercial |
$7.48
|
| Rate for Payer: Beech Street Commercial |
$7.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.56
|
| Rate for Payer: Cigna of WY Commercial |
$7.63
|
| Rate for Payer: Entrust Commercial |
$7.40
|
| Rate for Payer: First Choice Health Commercial |
$7.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.14
|
| Rate for Payer: HealthUtah PPO |
$7.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.56
|
| Rate for Payer: Multiplan Medicare/VA |
$4.88
|
| Rate for Payer: One Health Plan of WY PPO |
$7.63
|
| Rate for Payer: PacificSource Commercial |
$7.01
|
| Rate for Payer: PHCS PPO |
$7.63
|
| Rate for Payer: Three Rivers PPO |
$5.84
|
| Rate for Payer: TriWest Veterans Administration |
$5.14
|
| Rate for Payer: United Healthcare Commercial |
$6.78
|
| Rate for Payer: United Healthcare Medicare |
$5.14
|
| Rate for Payer: WINHealth Partners Commercial |
$7.40
|
| Rate for Payer: Wise Provider Network Commercial |
$7.40
|
|
|
SUT PDS II 1 CT-1
|
Facility
|
OP
|
$7.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$7.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.63
|
| Rate for Payer: Aetna of WY Medicare |
$5.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.48
|
| Rate for Payer: Altius Commercial |
$7.48
|
| Rate for Payer: Beech Street Commercial |
$7.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.56
|
| Rate for Payer: Cigna of WY Commercial |
$7.63
|
| Rate for Payer: Entrust Commercial |
$7.40
|
| Rate for Payer: First Choice Health Commercial |
$7.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.52
|
| Rate for Payer: HealthUtah PPO |
$7.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.56
|
| Rate for Payer: Multiplan Medicare/VA |
$4.29
|
| Rate for Payer: One Health Plan of WY PPO |
$7.63
|
| Rate for Payer: PacificSource Commercial |
$7.01
|
| Rate for Payer: PHCS PPO |
$7.63
|
| Rate for Payer: Three Rivers PPO |
$5.84
|
| Rate for Payer: TriWest Veterans Administration |
$4.52
|
| Rate for Payer: United Healthcare Commercial |
$6.78
|
| Rate for Payer: United Healthcare Medicare |
$4.52
|
| Rate for Payer: WINHealth Partners Commercial |
$7.63
|
| Rate for Payer: Wise Provider Network Commercial |
$7.40
|
|
|
SUT PDS PLUS 0 60" TP-1 LOOPED
|
Facility
|
IP
|
$14.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.77
|
| Rate for Payer: Altius Commercial |
$13.77
|
| Rate for Payer: Beech Street Commercial |
$14.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.77
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.91
|
| Rate for Payer: Cigna of WY Commercial |
$14.05
|
| Rate for Payer: Entrust Commercial |
$13.62
|
| Rate for Payer: First Choice Health Commercial |
$13.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.46
|
| Rate for Payer: HealthUtah PPO |
$14.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.91
|
| Rate for Payer: Multiplan Medicare/VA |
$8.99
|
| Rate for Payer: One Health Plan of WY PPO |
$14.05
|
| Rate for Payer: PacificSource Commercial |
$12.91
|
| Rate for Payer: PHCS PPO |
$14.05
|
| Rate for Payer: Three Rivers PPO |
$10.76
|
| Rate for Payer: TriWest Veterans Administration |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$12.48
|
| Rate for Payer: United Healthcare Medicare |
$9.46
|
| Rate for Payer: WINHealth Partners Commercial |
$13.62
|
| Rate for Payer: Wise Provider Network Commercial |
$13.62
|
|
|
SUT PDS PLUS 0 60" TP-1 LOOPED
|
Facility
|
OP
|
$14.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.05
|
| Rate for Payer: Aetna of WY Medicare |
$9.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.77
|
| Rate for Payer: Altius Commercial |
$13.77
|
| Rate for Payer: Beech Street Commercial |
$14.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.77
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.91
|
| Rate for Payer: Cigna of WY Commercial |
$14.05
|
| Rate for Payer: Entrust Commercial |
$13.62
|
| Rate for Payer: First Choice Health Commercial |
$13.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.32
|
| Rate for Payer: HealthUtah PPO |
$14.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.91
|
| Rate for Payer: Multiplan Medicare/VA |
$7.90
|
| Rate for Payer: One Health Plan of WY PPO |
$14.05
|
| Rate for Payer: PacificSource Commercial |
$12.91
|
| Rate for Payer: PHCS PPO |
$14.05
|
| Rate for Payer: Three Rivers PPO |
$10.76
|
| Rate for Payer: TriWest Veterans Administration |
$8.32
|
| Rate for Payer: United Healthcare Commercial |
$12.48
|
| Rate for Payer: United Healthcare Medicare |
$8.32
|
| Rate for Payer: WINHealth Partners Commercial |
$14.05
|
| Rate for Payer: Wise Provider Network Commercial |
$13.62
|
|
|
SUT PDS PLUS 1 54" TP-1
|
Facility
|
OP
|
$11.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$11.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.53
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.30
|
| Rate for Payer: Altius Commercial |
$11.30
|
| Rate for Payer: Beech Street Commercial |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.66
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.42
|
| Rate for Payer: Cigna of WY Commercial |
$11.53
|
| Rate for Payer: Entrust Commercial |
$11.18
|
| Rate for Payer: First Choice Health Commercial |
$11.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.83
|
| Rate for Payer: HealthUtah PPO |
$11.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.42
|
| Rate for Payer: Multiplan Medicare/VA |
$6.49
|
| Rate for Payer: One Health Plan of WY PPO |
$11.53
|
| Rate for Payer: PacificSource Commercial |
$10.59
|
| Rate for Payer: PHCS PPO |
$11.53
|
| Rate for Payer: Three Rivers PPO |
$8.83
|
| Rate for Payer: TriWest Veterans Administration |
$6.83
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
| Rate for Payer: United Healthcare Medicare |
$6.83
|
| Rate for Payer: WINHealth Partners Commercial |
$11.53
|
| Rate for Payer: Wise Provider Network Commercial |
$11.18
|
|
