|
SUT PDS PLUS 1 54" TP-1
|
Facility
|
IP
|
$11.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$11.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.53
|
| 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 |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$11.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.42
|
| Rate for Payer: Multiplan Medicare/VA |
$7.38
|
| 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 |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$11.18
|
| Rate for Payer: Wise Provider Network Commercial |
$11.18
|
|
|
SUT PEEK KNOTLESS CORKSCREW 3.9MM #5
|
Facility
|
OP
|
$1,635.20
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$1,635.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,602.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,079.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,569.79
|
| Rate for Payer: Altius Commercial |
$1,569.79
|
| Rate for Payer: Beech Street Commercial |
$1,602.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,342.50
|
| Rate for Payer: Cash Price |
$1,144.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,586.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,602.50
|
| Rate for Payer: Entrust Commercial |
$1,553.44
|
| Rate for Payer: First Choice Health Commercial |
$1,553.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,553.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$948.42
|
| Rate for Payer: HealthUtah PPO |
$1,635.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,586.14
|
| Rate for Payer: Multiplan Medicare/VA |
$901.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,602.50
|
| Rate for Payer: PacificSource Commercial |
$1,471.68
|
| Rate for Payer: PHCS PPO |
$1,602.50
|
| Rate for Payer: Three Rivers PPO |
$1,226.40
|
| Rate for Payer: TriWest Veterans Administration |
$948.42
|
| Rate for Payer: United Healthcare Commercial |
$1,422.62
|
| Rate for Payer: United Healthcare Medicare |
$948.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,602.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,553.44
|
|
|
SUT PEEK KNOTLESS CORKSCREW 3.9MM #5
|
Facility
|
IP
|
$1,635.20
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.27 |
| Max. Negotiated Rate |
$1,635.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,602.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,569.79
|
| Rate for Payer: Altius Commercial |
$1,569.79
|
| Rate for Payer: Beech Street Commercial |
$1,602.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,342.50
|
| Rate for Payer: Cash Price |
$1,144.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,586.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,602.50
|
| Rate for Payer: Entrust Commercial |
$1,553.44
|
| Rate for Payer: First Choice Health Commercial |
$1,553.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,553.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,079.23
|
| Rate for Payer: HealthUtah PPO |
$1,635.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,586.14
|
| Rate for Payer: Multiplan Medicare/VA |
$1,025.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,602.50
|
| Rate for Payer: PacificSource Commercial |
$1,471.68
|
| Rate for Payer: PHCS PPO |
$1,602.50
|
| Rate for Payer: Three Rivers PPO |
$1,226.40
|
| Rate for Payer: TriWest Veterans Administration |
$1,079.23
|
| Rate for Payer: United Healthcare Commercial |
$1,422.62
|
| Rate for Payer: United Healthcare Medicare |
$1,079.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,553.44
|
| Rate for Payer: Wise Provider Network Commercial |
$1,553.44
|
|
|
SUT PROLENE 6-0 BV-1 8806H
|
Facility
|
IP
|
$34.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$34.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.88
|
| Rate for Payer: Altius Commercial |
$32.88
|
| Rate for Payer: Beech Street Commercial |
$33.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.22
|
| Rate for Payer: Cigna of WY Commercial |
$33.56
|
| Rate for Payer: Entrust Commercial |
$32.54
|
| Rate for Payer: First Choice Health Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.60
|
| Rate for Payer: HealthUtah PPO |
$34.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.22
|
| Rate for Payer: Multiplan Medicare/VA |
$21.47
|
| Rate for Payer: One Health Plan of WY PPO |
$33.56
|
| Rate for Payer: PacificSource Commercial |
$30.82
|
| Rate for Payer: PHCS PPO |
$33.56
|
| Rate for Payer: Three Rivers PPO |
$25.69
|
| Rate for Payer: TriWest Veterans Administration |
$22.60
|
| Rate for Payer: United Healthcare Commercial |
$29.80
|
| Rate for Payer: United Healthcare Medicare |
$22.60
|
| Rate for Payer: WINHealth Partners Commercial |
$32.54
|
| Rate for Payer: Wise Provider Network Commercial |
$32.54
|
|
|
SUT PROLENE 6-0 BV-1 8806H
|
Facility
|
OP
|
$34.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$34.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.56
|
| Rate for Payer: Aetna of WY Medicare |
$22.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.88
|
| Rate for Payer: Altius Commercial |
$32.88
|
| Rate for Payer: Beech Street Commercial |
$33.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.22
|
| Rate for Payer: Cigna of WY Commercial |
$33.56
|
| Rate for Payer: Entrust Commercial |
$32.54
|
| Rate for Payer: First Choice Health Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.86
|
| Rate for Payer: HealthUtah PPO |
$34.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.22
|
| Rate for Payer: Multiplan Medicare/VA |
$18.87
|
| Rate for Payer: One Health Plan of WY PPO |
$33.56
|
| Rate for Payer: PacificSource Commercial |
$30.82
|
| Rate for Payer: PHCS PPO |
$33.56
|
| Rate for Payer: Three Rivers PPO |
$25.69
|
| Rate for Payer: TriWest Veterans Administration |
$19.86
|
| Rate for Payer: United Healthcare Commercial |
$29.80
|
| Rate for Payer: United Healthcare Medicare |
$19.86
|
| Rate for Payer: WINHealth Partners Commercial |
$33.56
|
| Rate for Payer: Wise Provider Network Commercial |
$32.54
|
|
|
SUT PROLENE 6-0 CT-1 2 8318H
|
Facility
|
OP
|
$28.94
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$28.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.36
|
| Rate for Payer: Aetna of WY Medicare |
$19.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.78
|
| Rate for Payer: Altius Commercial |
$27.78
|
| Rate for Payer: Beech Street Commercial |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.76
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.07
|
| Rate for Payer: Cigna of WY Commercial |
$28.36
|
| Rate for Payer: Entrust Commercial |
$27.49
|
| Rate for Payer: First Choice Health Commercial |
$27.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.79
|
| Rate for Payer: HealthUtah PPO |
$28.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.07
|
| Rate for Payer: Multiplan Medicare/VA |
$15.95
|
| Rate for Payer: One Health Plan of WY PPO |
$28.36
|
| Rate for Payer: PacificSource Commercial |
$26.05
|
| Rate for Payer: PHCS PPO |
$28.36
|
| Rate for Payer: Three Rivers PPO |
$21.70
|
| Rate for Payer: TriWest Veterans Administration |
$16.79
|
| Rate for Payer: United Healthcare Commercial |
$25.18
|
| Rate for Payer: United Healthcare Medicare |
$16.79
|
| Rate for Payer: WINHealth Partners Commercial |
$28.36
|
| Rate for Payer: Wise Provider Network Commercial |
$27.49
|
|
|
SUT PROLENE 6-0 CT-1 2 8318H
|
Facility
|
IP
|
$28.94
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$28.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.78
|
| Rate for Payer: Altius Commercial |
$27.78
|
| Rate for Payer: Beech Street Commercial |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.76
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.07
|
| Rate for Payer: Cigna of WY Commercial |
$28.36
|
| Rate for Payer: Entrust Commercial |
$27.49
|
| Rate for Payer: First Choice Health Commercial |
$27.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.10
|
| Rate for Payer: HealthUtah PPO |
$28.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.07
|
| Rate for Payer: Multiplan Medicare/VA |
$18.15
|
| Rate for Payer: One Health Plan of WY PPO |
$28.36
|
| Rate for Payer: PacificSource Commercial |
$26.05
|
| Rate for Payer: PHCS PPO |
$28.36
|
| Rate for Payer: Three Rivers PPO |
$21.70
|
| Rate for Payer: TriWest Veterans Administration |
$19.10
|
| Rate for Payer: United Healthcare Commercial |
$25.18
|
| Rate for Payer: United Healthcare Medicare |
$19.10
|
| Rate for Payer: WINHealth Partners Commercial |
$27.49
|
| Rate for Payer: Wise Provider Network Commercial |
$27.49
|
|
|
SUT QUILL 0 CT-1 RA-1067Q
|
Facility
|
OP
|
$56.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$56.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.75
|
| Rate for Payer: Aetna of WY Medicare |
$37.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.61
|
| Rate for Payer: Altius Commercial |
$54.61
|
| Rate for Payer: Beech Street Commercial |
$55.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.71
|
| Rate for Payer: Cash Price |
$39.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.18
|
| Rate for Payer: Cigna of WY Commercial |
$55.75
|
| Rate for Payer: Entrust Commercial |
$54.05
|
| Rate for Payer: First Choice Health Commercial |
$54.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.00
|
| Rate for Payer: HealthUtah PPO |
$56.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.18
|
| Rate for Payer: Multiplan Medicare/VA |
$31.35
|
| Rate for Payer: One Health Plan of WY PPO |
$55.75
|
| Rate for Payer: PacificSource Commercial |
$51.20
|
| Rate for Payer: PHCS PPO |
$55.75
|
| Rate for Payer: Three Rivers PPO |
$42.67
|
| Rate for Payer: TriWest Veterans Administration |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$49.49
|
| Rate for Payer: United Healthcare Medicare |
$33.00
|
| Rate for Payer: WINHealth Partners Commercial |
$55.75
|
| Rate for Payer: Wise Provider Network Commercial |
$54.05
|
|
|
SUT QUILL 0 CT-1 RA-1067Q
|
Facility
|
IP
|
$56.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$56.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.61
|
| Rate for Payer: Altius Commercial |
$54.61
|
| Rate for Payer: Beech Street Commercial |
$55.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.71
|
| Rate for Payer: Cash Price |
$39.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.18
|
| Rate for Payer: Cigna of WY Commercial |
$55.75
|
| Rate for Payer: Entrust Commercial |
$54.05
|
| Rate for Payer: First Choice Health Commercial |
$54.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.55
|
| Rate for Payer: HealthUtah PPO |
$56.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.18
|
| Rate for Payer: Multiplan Medicare/VA |
$35.67
|
| Rate for Payer: One Health Plan of WY PPO |
$55.75
|
| Rate for Payer: PacificSource Commercial |
$51.20
|
| Rate for Payer: PHCS PPO |
$55.75
|
| Rate for Payer: Three Rivers PPO |
$42.67
|
| Rate for Payer: TriWest Veterans Administration |
$37.55
|
| Rate for Payer: United Healthcare Commercial |
$49.49
|
| Rate for Payer: United Healthcare Medicare |
$37.55
|
| Rate for Payer: WINHealth Partners Commercial |
$54.05
|
| Rate for Payer: Wise Provider Network Commercial |
$54.05
|
|
|
SUT QUILL 2-0 18MM YA-1022Q-0
|
Facility
|
IP
|
$58.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.95
|
| Rate for Payer: Altius Commercial |
$55.95
|
| Rate for Payer: Beech Street Commercial |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.85
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.53
|
| Rate for Payer: Cigna of WY Commercial |
$57.11
|
| Rate for Payer: Entrust Commercial |
$55.37
|
| Rate for Payer: First Choice Health Commercial |
$55.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.46
|
| Rate for Payer: HealthUtah PPO |
$58.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.53
|
| Rate for Payer: Multiplan Medicare/VA |
$36.54
|
| Rate for Payer: One Health Plan of WY PPO |
$57.11
|
| Rate for Payer: PacificSource Commercial |
$52.45
|
| Rate for Payer: PHCS PPO |
$57.11
|
| Rate for Payer: Three Rivers PPO |
$43.71
|
| Rate for Payer: TriWest Veterans Administration |
$38.46
|
| Rate for Payer: United Healthcare Commercial |
$50.70
|
| Rate for Payer: United Healthcare Medicare |
$38.46
|
| Rate for Payer: WINHealth Partners Commercial |
$55.37
|
| Rate for Payer: Wise Provider Network Commercial |
$55.37
|
|
|
SUT QUILL 2-0 18MM YA-1022Q-0
|
Facility
|
OP
|
$58.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.11
|
| Rate for Payer: Aetna of WY Medicare |
$38.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.95
|
| Rate for Payer: Altius Commercial |
$55.95
|
| Rate for Payer: Beech Street Commercial |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.85
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.53
|
| Rate for Payer: Cigna of WY Commercial |
$57.11
|
| Rate for Payer: Entrust Commercial |
$55.37
|
| Rate for Payer: First Choice Health Commercial |
$55.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.80
|
| Rate for Payer: HealthUtah PPO |
$58.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.53
|
| Rate for Payer: Multiplan Medicare/VA |
$32.11
|
| Rate for Payer: One Health Plan of WY PPO |
$57.11
|
| Rate for Payer: PacificSource Commercial |
$52.45
|
| Rate for Payer: PHCS PPO |
$57.11
|
| Rate for Payer: Three Rivers PPO |
$43.71
|
| Rate for Payer: TriWest Veterans Administration |
$33.80
|
| Rate for Payer: United Healthcare Commercial |
$50.70
|
| Rate for Payer: United Healthcare Medicare |
$33.80
|
| Rate for Payer: WINHealth Partners Commercial |
$57.11
|
| Rate for Payer: Wise Provider Network Commercial |
$55.37
|
|
|
SUT QUILL 2 48MM RA-2065Q
|
Facility
|
IP
|
$62.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.44
|
| Rate for Payer: Altius Commercial |
$60.44
|
| Rate for Payer: Beech Street Commercial |
$61.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.69
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.07
|
| Rate for Payer: Cigna of WY Commercial |
$61.70
|
| Rate for Payer: Entrust Commercial |
$59.81
|
| Rate for Payer: First Choice Health Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.55
|
| Rate for Payer: HealthUtah PPO |
$62.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.07
|
| Rate for Payer: Multiplan Medicare/VA |
$39.48
|
| Rate for Payer: One Health Plan of WY PPO |
$61.70
|
| Rate for Payer: PacificSource Commercial |
$56.66
|
| Rate for Payer: PHCS PPO |
$61.70
|
| Rate for Payer: Three Rivers PPO |
$47.22
|
| Rate for Payer: TriWest Veterans Administration |
$41.55
|
| Rate for Payer: United Healthcare Commercial |
$54.78
|
| Rate for Payer: United Healthcare Medicare |
$41.55
|
| Rate for Payer: WINHealth Partners Commercial |
$59.81
|
| Rate for Payer: Wise Provider Network Commercial |
$59.81
|
|
|
SUT QUILL 2 48MM RA-2065Q
|
Facility
|
OP
|
$62.96
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.70
|
| Rate for Payer: Aetna of WY Medicare |
$41.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.44
|
| Rate for Payer: Altius Commercial |
$60.44
|
| Rate for Payer: Beech Street Commercial |
$61.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.69
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.07
|
| Rate for Payer: Cigna of WY Commercial |
$61.70
|
| Rate for Payer: Entrust Commercial |
$59.81
|
| Rate for Payer: First Choice Health Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.52
|
| Rate for Payer: HealthUtah PPO |
$62.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.69
|
| Rate for Payer: One Health Plan of WY PPO |
$61.70
|
| Rate for Payer: PacificSource Commercial |
$56.66
|
| Rate for Payer: PHCS PPO |
$61.70
|
| Rate for Payer: Three Rivers PPO |
$47.22
|
| Rate for Payer: TriWest Veterans Administration |
$36.52
|
| Rate for Payer: United Healthcare Commercial |
$54.78
|
| Rate for Payer: United Healthcare Medicare |
$36.52
|
| Rate for Payer: WINHealth Partners Commercial |
$61.70
|
| Rate for Payer: Wise Provider Network Commercial |
$59.81
|
|
|
SUT QUILL 3-0 18MM YA-1021Q-0
|
Facility
|
OP
|
$58.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.11
|
| Rate for Payer: Aetna of WY Medicare |
$38.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.95
|
| Rate for Payer: Altius Commercial |
$55.95
|
| Rate for Payer: Beech Street Commercial |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.85
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.53
|
| Rate for Payer: Cigna of WY Commercial |
$57.11
|
| Rate for Payer: Entrust Commercial |
$55.37
|
| Rate for Payer: First Choice Health Commercial |
$55.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.80
|
| Rate for Payer: HealthUtah PPO |
$58.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.53
|
| Rate for Payer: Multiplan Medicare/VA |
$32.11
|
| Rate for Payer: One Health Plan of WY PPO |
$57.11
|
| Rate for Payer: PacificSource Commercial |
$52.45
|
| Rate for Payer: PHCS PPO |
$57.11
|
| Rate for Payer: Three Rivers PPO |
$43.71
|
| Rate for Payer: TriWest Veterans Administration |
$33.80
|
| Rate for Payer: United Healthcare Commercial |
$50.70
|
| Rate for Payer: United Healthcare Medicare |
$33.80
|
| Rate for Payer: WINHealth Partners Commercial |
$57.11
|
| Rate for Payer: Wise Provider Network Commercial |
$55.37
|
|
|
SUT QUILL 3-0 18MM YA-1021Q-0
|
Facility
|
IP
|
$58.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.95
|
| Rate for Payer: Altius Commercial |
$55.95
|
| Rate for Payer: Beech Street Commercial |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.85
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.53
|
| Rate for Payer: Cigna of WY Commercial |
$57.11
|
| Rate for Payer: Entrust Commercial |
$55.37
|
| Rate for Payer: First Choice Health Commercial |
$55.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.46
|
| Rate for Payer: HealthUtah PPO |
$58.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.53
|
| Rate for Payer: Multiplan Medicare/VA |
$36.54
|
| Rate for Payer: One Health Plan of WY PPO |
$57.11
|
| Rate for Payer: PacificSource Commercial |
$52.45
|
| Rate for Payer: PHCS PPO |
$57.11
|
| Rate for Payer: Three Rivers PPO |
$43.71
|
| Rate for Payer: TriWest Veterans Administration |
$38.46
|
| Rate for Payer: United Healthcare Commercial |
$50.70
|
| Rate for Payer: United Healthcare Medicare |
$38.46
|
| Rate for Payer: WINHealth Partners Commercial |
$55.37
|
| Rate for Payer: Wise Provider Network Commercial |
$55.37
|
|
|
SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
HCPCS 64832 80
|
| Hospital Charge Code |
64832
|
| Min. Negotiated Rate |
$266.87 |
| Max. Negotiated Rate |
$3,558.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,486.84
|
| Rate for Payer: Aetna of WY Medicare |
$313.96
|
| Rate for Payer: Beech Street Commercial |
$3,380.10
|
| Rate for Payer: Cash Price |
$2,490.60
|
| Rate for Payer: Cash Price |
$2,490.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,451.26
|
| Rate for Payer: Cigna of WY Commercial |
$3,486.84
|
| Rate for Payer: First Choice Health Commercial |
$3,202.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,380.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.96
|
| Rate for Payer: HealthUtah PPO |
$3,558.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,451.26
|
| Rate for Payer: Multiplan Medicare/VA |
$266.87
|
| Rate for Payer: One Health Plan of WY PPO |
$3,486.84
|
| Rate for Payer: PacificSource Commercial |
$3,202.20
|
| Rate for Payer: PHCS PPO |
$3,380.10
|
| Rate for Payer: Three Rivers PPO |
$2,668.50
|
| Rate for Payer: TriWest Veterans Administration |
$313.96
|
| Rate for Payer: United Healthcare Commercial |
$3,095.46
|
| Rate for Payer: United Healthcare Medicare |
$313.96
|
| Rate for Payer: WINHealth Partners Commercial |
$3,024.30
|
|
|
SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
HCPCS 64832 AS
|
| Hospital Charge Code |
64832
|
| Min. Negotiated Rate |
$266.87 |
| Max. Negotiated Rate |
$3,558.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,486.84
|
| Rate for Payer: Aetna of WY Medicare |
$313.96
|
| Rate for Payer: Beech Street Commercial |
$3,380.10
|
| Rate for Payer: Cash Price |
$2,490.60
|
| Rate for Payer: Cash Price |
$2,490.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,451.26
|
| Rate for Payer: Cigna of WY Commercial |
$3,486.84
|
| Rate for Payer: First Choice Health Commercial |
$3,202.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,380.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.96
|
| Rate for Payer: HealthUtah PPO |
$3,558.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,451.26
|
| Rate for Payer: Multiplan Medicare/VA |
$266.87
|
| Rate for Payer: One Health Plan of WY PPO |
$3,486.84
|
| Rate for Payer: PacificSource Commercial |
$3,202.20
|
| Rate for Payer: PHCS PPO |
$3,380.10
|
| Rate for Payer: Three Rivers PPO |
$2,668.50
|
| Rate for Payer: TriWest Veterans Administration |
$313.96
|
| Rate for Payer: United Healthcare Commercial |
$3,095.46
|
| Rate for Payer: United Healthcare Medicare |
$313.96
|
| Rate for Payer: WINHealth Partners Commercial |
$3,024.30
|
|
|
SUT RETRIEVER HEWSON 71111579
|
Facility
|
IP
|
$282.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.38 |
| Max. Negotiated Rate |
$282.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$271.58
|
| Rate for Payer: Altius Commercial |
$271.58
|
| Rate for Payer: Beech Street Commercial |
$277.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$232.26
|
| Rate for Payer: Cash Price |
$198.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.41
|
| Rate for Payer: Cigna of WY Commercial |
$277.24
|
| Rate for Payer: Entrust Commercial |
$268.76
|
| Rate for Payer: First Choice Health Commercial |
$268.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.71
|
| Rate for Payer: HealthUtah PPO |
$282.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.41
|
| Rate for Payer: Multiplan Medicare/VA |
$177.38
|
| Rate for Payer: One Health Plan of WY PPO |
$277.24
|
| Rate for Payer: PacificSource Commercial |
$254.61
|
| Rate for Payer: PHCS PPO |
$277.24
|
| Rate for Payer: Three Rivers PPO |
$212.18
|
| Rate for Payer: TriWest Veterans Administration |
$186.71
|
| Rate for Payer: United Healthcare Commercial |
$246.12
|
| Rate for Payer: United Healthcare Medicare |
$186.71
|
| Rate for Payer: WINHealth Partners Commercial |
$268.76
|
| Rate for Payer: Wise Provider Network Commercial |
$268.76
|
|
|
SUT RETRIEVER HEWSON 71111579
|
Facility
|
OP
|
$282.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.88 |
| Max. Negotiated Rate |
$282.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.24
|
| Rate for Payer: Aetna of WY Medicare |
$186.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$271.58
|
| Rate for Payer: Altius Commercial |
$271.58
|
| Rate for Payer: Beech Street Commercial |
$277.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$232.26
|
| Rate for Payer: Cash Price |
$198.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.41
|
| Rate for Payer: Cigna of WY Commercial |
$277.24
|
| Rate for Payer: Entrust Commercial |
$268.76
|
| Rate for Payer: First Choice Health Commercial |
$268.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.08
|
| Rate for Payer: HealthUtah PPO |
$282.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.41
|
| Rate for Payer: Multiplan Medicare/VA |
$155.88
|
| Rate for Payer: One Health Plan of WY PPO |
$277.24
|
| Rate for Payer: PacificSource Commercial |
$254.61
|
| Rate for Payer: PHCS PPO |
$277.24
|
| Rate for Payer: Three Rivers PPO |
$212.18
|
| Rate for Payer: TriWest Veterans Administration |
$164.08
|
| Rate for Payer: United Healthcare Commercial |
$246.12
|
| Rate for Payer: United Healthcare Medicare |
$164.08
|
| Rate for Payer: WINHealth Partners Commercial |
$277.24
|
| Rate for Payer: Wise Provider Network Commercial |
$268.76
|
|
|
SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,556.00
|
|
|
Service Code
|
HCPCS 44604 80
|
| Hospital Charge Code |
44604
|
| Min. Negotiated Rate |
$847.05 |
| Max. Negotiated Rate |
$3,556.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,484.88
|
| Rate for Payer: Aetna of WY Medicare |
$996.53
|
| Rate for Payer: Beech Street Commercial |
$3,378.20
|
| Rate for Payer: Cash Price |
$2,489.20
|
| Rate for Payer: Cash Price |
$2,489.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,449.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,484.88
|
| Rate for Payer: First Choice Health Commercial |
$3,200.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,378.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$996.53
|
| Rate for Payer: HealthUtah PPO |
$3,556.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,449.32
|
| Rate for Payer: Multiplan Medicare/VA |
$847.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,484.88
|
| Rate for Payer: PacificSource Commercial |
$3,200.40
|
| Rate for Payer: PHCS PPO |
$3,378.20
|
| Rate for Payer: Three Rivers PPO |
$2,667.00
|
| Rate for Payer: TriWest Veterans Administration |
$996.53
|
| Rate for Payer: United Healthcare Commercial |
$3,093.72
|
| Rate for Payer: United Healthcare Medicare |
$996.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,022.60
|
|
|
SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,556.00
|
|
|
Service Code
|
HCPCS 44604 AS
|
| Hospital Charge Code |
44604
|
| Min. Negotiated Rate |
$847.05 |
| Max. Negotiated Rate |
$3,556.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,484.88
|
| Rate for Payer: Aetna of WY Medicare |
$996.53
|
| Rate for Payer: Beech Street Commercial |
$3,378.20
|
| Rate for Payer: Cash Price |
$2,489.20
|
| Rate for Payer: Cash Price |
$2,489.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,449.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,484.88
|
| Rate for Payer: First Choice Health Commercial |
$3,200.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,378.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$996.53
|
| Rate for Payer: HealthUtah PPO |
$3,556.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,449.32
|
| Rate for Payer: Multiplan Medicare/VA |
$847.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,484.88
|
| Rate for Payer: PacificSource Commercial |
$3,200.40
|
| Rate for Payer: PHCS PPO |
$3,378.20
|
| Rate for Payer: Three Rivers PPO |
$2,667.00
|
| Rate for Payer: TriWest Veterans Administration |
$996.53
|
| Rate for Payer: United Healthcare Commercial |
$3,093.72
|
| Rate for Payer: United Healthcare Medicare |
$996.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,022.60
|
|
|
SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,556.00
|
|
|
Service Code
|
HCPCS 44604
|
| Hospital Charge Code |
44604
|
| Min. Negotiated Rate |
$847.05 |
| Max. Negotiated Rate |
$3,556.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,484.88
|
| Rate for Payer: Aetna of WY Medicare |
$996.53
|
| Rate for Payer: Beech Street Commercial |
$3,378.20
|
| Rate for Payer: Cash Price |
$2,489.20
|
| Rate for Payer: Cash Price |
$2,489.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,449.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,484.88
|
| Rate for Payer: First Choice Health Commercial |
$3,200.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,378.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$996.53
|
| Rate for Payer: HealthUtah PPO |
$3,556.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,449.32
|
| Rate for Payer: Multiplan Medicare/VA |
$847.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,484.88
|
| Rate for Payer: PacificSource Commercial |
$3,200.40
|
| Rate for Payer: PHCS PPO |
$3,378.20
|
| Rate for Payer: Three Rivers PPO |
$2,667.00
|
| Rate for Payer: TriWest Veterans Administration |
$996.53
|
| Rate for Payer: United Healthcare Commercial |
$3,093.72
|
| Rate for Payer: United Healthcare Medicare |
$996.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,022.60
|
|
|
SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS
|
Professional
|
Both
|
$5,335.00
|
|
|
Service Code
|
HCPCS 64857
|
| Hospital Charge Code |
64857
|
| Min. Negotiated Rate |
$858.36 |
| Max. Negotiated Rate |
$5,335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,228.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,009.83
|
| Rate for Payer: Beech Street Commercial |
$5,068.25
|
| Rate for Payer: Cash Price |
$3,734.50
|
| Rate for Payer: Cash Price |
$3,734.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,174.95
|
| Rate for Payer: Cigna of WY Commercial |
$5,228.30
|
| Rate for Payer: First Choice Health Commercial |
$4,801.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,068.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,009.83
|
| Rate for Payer: HealthUtah PPO |
$5,335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,174.95
|
| Rate for Payer: Multiplan Medicare/VA |
$858.36
|
| Rate for Payer: One Health Plan of WY PPO |
$5,228.30
|
| Rate for Payer: PacificSource Commercial |
$4,801.50
|
| Rate for Payer: PHCS PPO |
$5,068.25
|
| Rate for Payer: Three Rivers PPO |
$4,001.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,009.83
|
| Rate for Payer: United Healthcare Commercial |
$4,641.45
|
| Rate for Payer: United Healthcare Medicare |
$1,009.83
|
| Rate for Payer: WINHealth Partners Commercial |
$4,534.75
|
|
|
SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS
|
Professional
|
Both
|
$5,335.00
|
|
|
Service Code
|
HCPCS 64857 AS
|
| Hospital Charge Code |
64857
|
| Min. Negotiated Rate |
$858.36 |
| Max. Negotiated Rate |
$5,335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,228.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,009.83
|
| Rate for Payer: Beech Street Commercial |
$5,068.25
|
| Rate for Payer: Cash Price |
$3,734.50
|
| Rate for Payer: Cash Price |
$3,734.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,174.95
|
| Rate for Payer: Cigna of WY Commercial |
$5,228.30
|
| Rate for Payer: First Choice Health Commercial |
$4,801.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,068.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,009.83
|
| Rate for Payer: HealthUtah PPO |
$5,335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,174.95
|
| Rate for Payer: Multiplan Medicare/VA |
$858.36
|
| Rate for Payer: One Health Plan of WY PPO |
$5,228.30
|
| Rate for Payer: PacificSource Commercial |
$4,801.50
|
| Rate for Payer: PHCS PPO |
$5,068.25
|
| Rate for Payer: Three Rivers PPO |
$4,001.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,009.83
|
| Rate for Payer: United Healthcare Commercial |
$4,641.45
|
| Rate for Payer: United Healthcare Medicare |
$1,009.83
|
| Rate for Payer: WINHealth Partners Commercial |
$4,534.75
|
|
|
SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ
|
Professional
|
Both
|
$2,972.00
|
|
|
Service Code
|
HCPCS 27386
|
| Hospital Charge Code |
27386
|
| Min. Negotiated Rate |
$707.45 |
| Max. Negotiated Rate |
$2,972.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,912.56
|
| Rate for Payer: Aetna of WY Medicare |
$832.29
|
| Rate for Payer: Beech Street Commercial |
$2,823.40
|
| Rate for Payer: Cash Price |
$2,080.40
|
| Rate for Payer: Cash Price |
$2,080.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,882.84
|
| Rate for Payer: Cigna of WY Commercial |
$2,912.56
|
| Rate for Payer: First Choice Health Commercial |
$2,674.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,823.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$832.29
|
| Rate for Payer: HealthUtah PPO |
$2,972.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,882.84
|
| Rate for Payer: Multiplan Medicare/VA |
$707.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2,912.56
|
| Rate for Payer: PacificSource Commercial |
$2,674.80
|
| Rate for Payer: PHCS PPO |
$2,823.40
|
| Rate for Payer: Three Rivers PPO |
$2,229.00
|
| Rate for Payer: TriWest Veterans Administration |
$832.29
|
| Rate for Payer: United Healthcare Commercial |
$2,585.64
|
| Rate for Payer: United Healthcare Medicare |
$832.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,526.20
|
|
