|
SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 27385 80
|
| Hospital Charge Code |
27385
|
| Min. Negotiated Rate |
$505.72 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,081.52
|
| Rate for Payer: Aetna of WY Medicare |
$594.96
|
| Rate for Payer: Beech Street Commercial |
$2,017.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,060.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,081.52
|
| Rate for Payer: First Choice Health Commercial |
$1,911.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,017.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.96
|
| Rate for Payer: HealthUtah PPO |
$2,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,060.28
|
| Rate for Payer: Multiplan Medicare/VA |
$505.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,081.52
|
| Rate for Payer: PacificSource Commercial |
$1,911.60
|
| Rate for Payer: PHCS PPO |
$2,017.80
|
| Rate for Payer: Three Rivers PPO |
$1,593.00
|
| Rate for Payer: TriWest Veterans Administration |
$594.96
|
| Rate for Payer: United Healthcare Commercial |
$1,847.88
|
| Rate for Payer: United Healthcare Medicare |
$594.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.40
|
|
|
SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 27385
|
| Hospital Charge Code |
27385
|
| Min. Negotiated Rate |
$505.72 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,081.52
|
| Rate for Payer: Aetna of WY Medicare |
$594.96
|
| Rate for Payer: Beech Street Commercial |
$2,017.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,060.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,081.52
|
| Rate for Payer: First Choice Health Commercial |
$1,911.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,017.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.96
|
| Rate for Payer: HealthUtah PPO |
$2,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,060.28
|
| Rate for Payer: Multiplan Medicare/VA |
$505.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,081.52
|
| Rate for Payer: PacificSource Commercial |
$1,911.60
|
| Rate for Payer: PHCS PPO |
$2,017.80
|
| Rate for Payer: Three Rivers PPO |
$1,593.00
|
| Rate for Payer: TriWest Veterans Administration |
$594.96
|
| Rate for Payer: United Healthcare Commercial |
$1,847.88
|
| Rate for Payer: United Healthcare Medicare |
$594.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.40
|
|
|
SUTURE REMOVAL KIT DISP
|
Facility
|
IP
|
$7.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.03
|
| Rate for Payer: Altius Commercial |
$7.03
|
| Rate for Payer: Beech Street Commercial |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.10
|
| Rate for Payer: Cigna of WY Commercial |
$7.17
|
| Rate for Payer: Entrust Commercial |
$6.95
|
| Rate for Payer: First Choice Health Commercial |
$6.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.83
|
| Rate for Payer: HealthUtah PPO |
$7.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.10
|
| Rate for Payer: Multiplan Medicare/VA |
$4.59
|
| Rate for Payer: One Health Plan of WY PPO |
$7.17
|
| Rate for Payer: PacificSource Commercial |
$6.59
|
| Rate for Payer: PHCS PPO |
$7.17
|
| Rate for Payer: Three Rivers PPO |
$5.49
|
| Rate for Payer: TriWest Veterans Administration |
$4.83
|
| Rate for Payer: United Healthcare Commercial |
$6.37
|
| Rate for Payer: United Healthcare Medicare |
$4.83
|
| Rate for Payer: WINHealth Partners Commercial |
$6.95
|
| Rate for Payer: Wise Provider Network Commercial |
$6.95
|
|
|
SUTURE REMOVAL KIT DISP
|
Facility
|
OP
|
$7.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.17
|
| Rate for Payer: Aetna of WY Medicare |
$4.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.03
|
| Rate for Payer: Altius Commercial |
$7.03
|
| Rate for Payer: Beech Street Commercial |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.10
|
| Rate for Payer: Cigna of WY Commercial |
$7.17
|
| Rate for Payer: Entrust Commercial |
$6.95
|
| Rate for Payer: First Choice Health Commercial |
$6.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.25
|
| Rate for Payer: HealthUtah PPO |
$7.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.10
|
| Rate for Payer: Multiplan Medicare/VA |
$4.03
|
| Rate for Payer: One Health Plan of WY PPO |
$7.17
|
| Rate for Payer: PacificSource Commercial |
$6.59
|
| Rate for Payer: PHCS PPO |
$7.17
|
| Rate for Payer: Three Rivers PPO |
$5.49
|
| Rate for Payer: TriWest Veterans Administration |
$4.25
|
| Rate for Payer: United Healthcare Commercial |
$6.37
|
| Rate for Payer: United Healthcare Medicare |
$4.25
|
| Rate for Payer: WINHealth Partners Commercial |
$7.17
|
| Rate for Payer: Wise Provider Network Commercial |
$6.95
|
|
|
SUTURETAK 3MM INSERT 1934PI-30
|
Facility
|
IP
|
$797.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.82 |
| Max. Negotiated Rate |
$797.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$765.27
|
| Rate for Payer: Altius Commercial |
$765.27
|
| Rate for Payer: Beech Street Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$654.47
|
| Rate for Payer: Cash Price |
$558.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.25
|
| Rate for Payer: Cigna of WY Commercial |
$781.22
|
| Rate for Payer: Entrust Commercial |
$757.30
|
| Rate for Payer: First Choice Health Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$526.13
|
| Rate for Payer: HealthUtah PPO |
$797.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.25
|
| Rate for Payer: Multiplan Medicare/VA |
$499.82
|
| Rate for Payer: One Health Plan of WY PPO |
$781.22
|
| Rate for Payer: PacificSource Commercial |
$717.44
|
| Rate for Payer: PHCS PPO |
$781.22
|
| Rate for Payer: Three Rivers PPO |
$597.87
|
| Rate for Payer: TriWest Veterans Administration |
$526.13
|
| Rate for Payer: United Healthcare Commercial |
$693.53
|
| Rate for Payer: United Healthcare Medicare |
$526.13
|
| Rate for Payer: WINHealth Partners Commercial |
$757.30
|
| Rate for Payer: Wise Provider Network Commercial |
$757.30
|
|
|
SUTURETAK 3MM INSERT 1934PI-30
|
Facility
|
OP
|
$797.16
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.24 |
| Max. Negotiated Rate |
$797.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.22
|
| Rate for Payer: Aetna of WY Medicare |
$526.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$765.27
|
| Rate for Payer: Altius Commercial |
$765.27
|
| Rate for Payer: Beech Street Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$654.47
|
| Rate for Payer: Cash Price |
$558.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.25
|
| Rate for Payer: Cigna of WY Commercial |
$781.22
|
| Rate for Payer: Entrust Commercial |
$757.30
|
| Rate for Payer: First Choice Health Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.35
|
| Rate for Payer: HealthUtah PPO |
$797.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.25
|
| Rate for Payer: Multiplan Medicare/VA |
$439.24
|
| Rate for Payer: One Health Plan of WY PPO |
$781.22
|
| Rate for Payer: PacificSource Commercial |
$717.44
|
| Rate for Payer: PHCS PPO |
$781.22
|
| Rate for Payer: Three Rivers PPO |
$597.87
|
| Rate for Payer: TriWest Veterans Administration |
$462.35
|
| Rate for Payer: United Healthcare Commercial |
$693.53
|
| Rate for Payer: United Healthcare Medicare |
$462.35
|
| Rate for Payer: WINHealth Partners Commercial |
$781.22
|
| Rate for Payer: Wise Provider Network Commercial |
$757.30
|
|
|
SUTURETAK ANCHOR 3X12 1934PS-2
|
Facility
|
IP
|
$1,042.44
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.61 |
| Max. Negotiated Rate |
$1,042.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,021.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,000.74
|
| Rate for Payer: Altius Commercial |
$1,000.74
|
| Rate for Payer: Beech Street Commercial |
$1,021.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$855.84
|
| Rate for Payer: Cash Price |
$729.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,011.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,021.59
|
| Rate for Payer: Entrust Commercial |
$990.32
|
| Rate for Payer: First Choice Health Commercial |
$990.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$990.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$688.01
|
| Rate for Payer: HealthUtah PPO |
$1,042.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,011.17
|
| Rate for Payer: Multiplan Medicare/VA |
$653.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,021.59
|
| Rate for Payer: PacificSource Commercial |
$938.20
|
| Rate for Payer: PHCS PPO |
$1,021.59
|
| Rate for Payer: Three Rivers PPO |
$781.83
|
| Rate for Payer: TriWest Veterans Administration |
$688.01
|
| Rate for Payer: United Healthcare Commercial |
$906.92
|
| Rate for Payer: United Healthcare Medicare |
$688.01
|
| Rate for Payer: WINHealth Partners Commercial |
$990.32
|
| Rate for Payer: Wise Provider Network Commercial |
$990.32
|
|
|
SUTURETAK ANCHOR 3X12 1934PS-2
|
Facility
|
OP
|
$1,042.44
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.38 |
| Max. Negotiated Rate |
$1,042.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,021.59
|
| Rate for Payer: Aetna of WY Medicare |
$688.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,000.74
|
| Rate for Payer: Altius Commercial |
$1,000.74
|
| Rate for Payer: Beech Street Commercial |
$1,021.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$855.84
|
| Rate for Payer: Cash Price |
$729.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,011.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,021.59
|
| Rate for Payer: Entrust Commercial |
$990.32
|
| Rate for Payer: First Choice Health Commercial |
$990.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$990.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$604.62
|
| Rate for Payer: HealthUtah PPO |
$1,042.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,011.17
|
| Rate for Payer: Multiplan Medicare/VA |
$574.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,021.59
|
| Rate for Payer: PacificSource Commercial |
$938.20
|
| Rate for Payer: PHCS PPO |
$1,021.59
|
| Rate for Payer: Three Rivers PPO |
$781.83
|
| Rate for Payer: TriWest Veterans Administration |
$604.62
|
| Rate for Payer: United Healthcare Commercial |
$906.92
|
| Rate for Payer: United Healthcare Medicare |
$604.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,021.59
|
| Rate for Payer: Wise Provider Network Commercial |
$990.32
|
|
|
SUTURETAK MINI KIT AR-1322DSC
|
Facility
|
IP
|
$715.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.56 |
| Max. Negotiated Rate |
$715.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$701.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$686.78
|
| Rate for Payer: Altius Commercial |
$686.78
|
| Rate for Payer: Beech Street Commercial |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$587.34
|
| Rate for Payer: Cash Price |
$500.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$693.94
|
| Rate for Payer: Cigna of WY Commercial |
$701.09
|
| Rate for Payer: Entrust Commercial |
$679.63
|
| Rate for Payer: First Choice Health Commercial |
$679.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$679.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$472.16
|
| Rate for Payer: HealthUtah PPO |
$715.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$693.94
|
| Rate for Payer: Multiplan Medicare/VA |
$448.56
|
| Rate for Payer: One Health Plan of WY PPO |
$701.09
|
| Rate for Payer: PacificSource Commercial |
$643.86
|
| Rate for Payer: PHCS PPO |
$701.09
|
| Rate for Payer: Three Rivers PPO |
$536.55
|
| Rate for Payer: TriWest Veterans Administration |
$472.16
|
| Rate for Payer: United Healthcare Commercial |
$622.40
|
| Rate for Payer: United Healthcare Medicare |
$472.16
|
| Rate for Payer: WINHealth Partners Commercial |
$679.63
|
| Rate for Payer: Wise Provider Network Commercial |
$679.63
|
|
|
SUTURETAK MINI KIT AR-1322DSC
|
Facility
|
OP
|
$715.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.19 |
| Max. Negotiated Rate |
$715.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$701.09
|
| Rate for Payer: Aetna of WY Medicare |
$472.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$686.78
|
| Rate for Payer: Altius Commercial |
$686.78
|
| Rate for Payer: Beech Street Commercial |
$701.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$587.34
|
| Rate for Payer: Cash Price |
$500.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$693.94
|
| Rate for Payer: Cigna of WY Commercial |
$701.09
|
| Rate for Payer: Entrust Commercial |
$679.63
|
| Rate for Payer: First Choice Health Commercial |
$679.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$679.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$414.93
|
| Rate for Payer: HealthUtah PPO |
$715.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$693.94
|
| Rate for Payer: Multiplan Medicare/VA |
$394.19
|
| Rate for Payer: One Health Plan of WY PPO |
$701.09
|
| Rate for Payer: PacificSource Commercial |
$643.86
|
| Rate for Payer: PHCS PPO |
$701.09
|
| Rate for Payer: Three Rivers PPO |
$536.55
|
| Rate for Payer: TriWest Veterans Administration |
$414.93
|
| Rate for Payer: United Healthcare Commercial |
$622.40
|
| Rate for Payer: United Healthcare Medicare |
$414.93
|
| Rate for Payer: WINHealth Partners Commercial |
$701.09
|
| Rate for Payer: Wise Provider Network Commercial |
$679.63
|
|
|
SUTURETAPE 1.3 36.6MM AR-7506
|
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
|
|
|
SUTURETAPE 1.3 36.6MM AR-7506
|
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
|
|
|
SUTURETAPE 1.3 36.6MM AR-7506T
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$96.42
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$101.50
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
SUTURETAPE 1.3 36.6MM AR-7506T
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.50
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$109.72
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$152.25
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
SUTURETAPE 1.3MM 40" AR-7500
|
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
|
|
|
SUTURETAPE 1.3MM 40" AR-7500
|
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
|
|
|
SUTURETAPE MENISCUS REPAIR 0.9MM
|
Facility
|
IP
|
$45.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.68
|
| Rate for Payer: Altius Commercial |
$43.68
|
| Rate for Payer: Beech Street Commercial |
$44.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.36
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.14
|
| Rate for Payer: Cigna of WY Commercial |
$44.59
|
| Rate for Payer: Entrust Commercial |
$43.22
|
| Rate for Payer: First Choice Health Commercial |
$43.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.03
|
| Rate for Payer: HealthUtah PPO |
$45.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.14
|
| Rate for Payer: Multiplan Medicare/VA |
$28.53
|
| Rate for Payer: One Health Plan of WY PPO |
$44.59
|
| Rate for Payer: PacificSource Commercial |
$40.95
|
| Rate for Payer: PHCS PPO |
$44.59
|
| Rate for Payer: Three Rivers PPO |
$34.12
|
| Rate for Payer: TriWest Veterans Administration |
$30.03
|
| Rate for Payer: United Healthcare Commercial |
$39.58
|
| Rate for Payer: United Healthcare Medicare |
$30.03
|
| Rate for Payer: WINHealth Partners Commercial |
$43.22
|
| Rate for Payer: Wise Provider Network Commercial |
$43.22
|
|
|
SUTURETAPE MENISCUS REPAIR 0.9MM
|
Facility
|
OP
|
$45.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.59
|
| Rate for Payer: Aetna of WY Medicare |
$30.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.68
|
| Rate for Payer: Altius Commercial |
$43.68
|
| Rate for Payer: Beech Street Commercial |
$44.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.36
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.14
|
| Rate for Payer: Cigna of WY Commercial |
$44.59
|
| Rate for Payer: Entrust Commercial |
$43.22
|
| Rate for Payer: First Choice Health Commercial |
$43.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.39
|
| Rate for Payer: HealthUtah PPO |
$45.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.14
|
| Rate for Payer: Multiplan Medicare/VA |
$25.07
|
| Rate for Payer: One Health Plan of WY PPO |
$44.59
|
| Rate for Payer: PacificSource Commercial |
$40.95
|
| Rate for Payer: PHCS PPO |
$44.59
|
| Rate for Payer: Three Rivers PPO |
$34.12
|
| Rate for Payer: TriWest Veterans Administration |
$26.39
|
| Rate for Payer: United Healthcare Commercial |
$39.58
|
| Rate for Payer: United Healthcare Medicare |
$26.39
|
| Rate for Payer: WINHealth Partners Commercial |
$44.59
|
| Rate for Payer: Wise Provider Network Commercial |
$43.22
|
|
|
SUT VICRYL 2-0 CP-2 18" 8PK
|
Facility
|
IP
|
$38.66
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.11
|
| Rate for Payer: Altius Commercial |
$37.11
|
| Rate for Payer: Beech Street Commercial |
$37.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.74
|
| Rate for Payer: Cash Price |
$27.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.50
|
| Rate for Payer: Cigna of WY Commercial |
$37.89
|
| Rate for Payer: Entrust Commercial |
$36.73
|
| Rate for Payer: First Choice Health Commercial |
$36.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.52
|
| Rate for Payer: HealthUtah PPO |
$38.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.50
|
| Rate for Payer: Multiplan Medicare/VA |
$24.24
|
| Rate for Payer: One Health Plan of WY PPO |
$37.89
|
| Rate for Payer: PacificSource Commercial |
$34.79
|
| Rate for Payer: PHCS PPO |
$37.89
|
| Rate for Payer: Three Rivers PPO |
$29.00
|
| Rate for Payer: TriWest Veterans Administration |
$25.52
|
| Rate for Payer: United Healthcare Commercial |
$33.63
|
| Rate for Payer: United Healthcare Medicare |
$25.52
|
| Rate for Payer: WINHealth Partners Commercial |
$36.73
|
| Rate for Payer: Wise Provider Network Commercial |
$36.73
|
|
|
SUT VICRYL 2-0 CP-2 18" 8PK
|
Facility
|
OP
|
$38.66
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.89
|
| Rate for Payer: Aetna of WY Medicare |
$25.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.11
|
| Rate for Payer: Altius Commercial |
$37.11
|
| Rate for Payer: Beech Street Commercial |
$37.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.74
|
| Rate for Payer: Cash Price |
$27.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.50
|
| Rate for Payer: Cigna of WY Commercial |
$37.89
|
| Rate for Payer: Entrust Commercial |
$36.73
|
| Rate for Payer: First Choice Health Commercial |
$36.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.42
|
| Rate for Payer: HealthUtah PPO |
$38.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.50
|
| Rate for Payer: Multiplan Medicare/VA |
$21.30
|
| Rate for Payer: One Health Plan of WY PPO |
$37.89
|
| Rate for Payer: PacificSource Commercial |
$34.79
|
| Rate for Payer: PHCS PPO |
$37.89
|
| Rate for Payer: Three Rivers PPO |
$29.00
|
| Rate for Payer: TriWest Veterans Administration |
$22.42
|
| Rate for Payer: United Healthcare Commercial |
$33.63
|
| Rate for Payer: United Healthcare Medicare |
$22.42
|
| Rate for Payer: WINHealth Partners Commercial |
$37.89
|
| Rate for Payer: Wise Provider Network Commercial |
$36.73
|
|
|
SUT VICRYL PLUS 0 36" CT-1
|
Facility
|
IP
|
$5.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.81
|
| Rate for Payer: Altius Commercial |
$4.81
|
| Rate for Payer: Beech Street Commercial |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.11
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.86
|
| Rate for Payer: Cigna of WY Commercial |
$4.91
|
| Rate for Payer: Entrust Commercial |
$4.76
|
| Rate for Payer: First Choice Health Commercial |
$4.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.31
|
| Rate for Payer: HealthUtah PPO |
$5.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.86
|
| Rate for Payer: Multiplan Medicare/VA |
$3.14
|
| Rate for Payer: One Health Plan of WY PPO |
$4.91
|
| Rate for Payer: PacificSource Commercial |
$4.51
|
| Rate for Payer: PHCS PPO |
$4.91
|
| Rate for Payer: Three Rivers PPO |
$3.76
|
| Rate for Payer: TriWest Veterans Administration |
$3.31
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
| Rate for Payer: United Healthcare Medicare |
$3.31
|
| Rate for Payer: WINHealth Partners Commercial |
$4.76
|
| Rate for Payer: Wise Provider Network Commercial |
$4.76
|
|
|
SUT VICRYL PLUS 0 36" CT-1
|
Facility
|
OP
|
$5.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.91
|
| Rate for Payer: Aetna of WY Medicare |
$3.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.81
|
| Rate for Payer: Altius Commercial |
$4.81
|
| Rate for Payer: Beech Street Commercial |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.11
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.86
|
| Rate for Payer: Cigna of WY Commercial |
$4.91
|
| Rate for Payer: Entrust Commercial |
$4.76
|
| Rate for Payer: First Choice Health Commercial |
$4.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.91
|
| Rate for Payer: HealthUtah PPO |
$5.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.86
|
| Rate for Payer: Multiplan Medicare/VA |
$2.76
|
| Rate for Payer: One Health Plan of WY PPO |
$4.91
|
| Rate for Payer: PacificSource Commercial |
$4.51
|
| Rate for Payer: PHCS PPO |
$4.91
|
| Rate for Payer: Three Rivers PPO |
$3.76
|
| Rate for Payer: TriWest Veterans Administration |
$2.91
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
| Rate for Payer: United Healthcare Medicare |
$2.91
|
| Rate for Payer: WINHealth Partners Commercial |
$4.91
|
| Rate for Payer: Wise Provider Network Commercial |
$4.76
|
|
|
SUT VICRYL PLUS 0 CT-1 27" 8PK
|
Facility
|
IP
|
$33.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.41
|
| Rate for Payer: Altius Commercial |
$32.41
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.72
|
| Rate for Payer: Cash Price |
$23.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.75
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Entrust Commercial |
$32.07
|
| Rate for Payer: First Choice Health Commercial |
$32.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.28
|
| Rate for Payer: HealthUtah PPO |
$33.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.75
|
| Rate for Payer: Multiplan Medicare/VA |
$21.17
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: Three Rivers PPO |
$25.32
|
| Rate for Payer: TriWest Veterans Administration |
$22.28
|
| Rate for Payer: United Healthcare Commercial |
$29.37
|
| Rate for Payer: United Healthcare Medicare |
$22.28
|
| Rate for Payer: WINHealth Partners Commercial |
$32.07
|
| Rate for Payer: Wise Provider Network Commercial |
$32.07
|
|
|
SUT VICRYL PLUS 0 CT-1 27" 8PK
|
Facility
|
OP
|
$33.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Aetna of WY Medicare |
$22.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.41
|
| Rate for Payer: Altius Commercial |
$32.41
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.72
|
| Rate for Payer: Cash Price |
$23.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.75
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Entrust Commercial |
$32.07
|
| Rate for Payer: First Choice Health Commercial |
$32.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.58
|
| Rate for Payer: HealthUtah PPO |
$33.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.75
|
| Rate for Payer: Multiplan Medicare/VA |
$18.60
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: Three Rivers PPO |
$25.32
|
| Rate for Payer: TriWest Veterans Administration |
$19.58
|
| Rate for Payer: United Healthcare Commercial |
$29.37
|
| Rate for Payer: United Healthcare Medicare |
$19.58
|
| Rate for Payer: WINHealth Partners Commercial |
$33.08
|
| Rate for Payer: Wise Provider Network Commercial |
$32.07
|
|
|
SUT VICRYL PLUS 0 CT-2 18" 8PK
|
Facility
|
IP
|
$32.78
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$32.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.47
|
| Rate for Payer: Altius Commercial |
$31.47
|
| Rate for Payer: Beech Street Commercial |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.91
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.80
|
| Rate for Payer: Cigna of WY Commercial |
$32.12
|
| Rate for Payer: Entrust Commercial |
$31.14
|
| Rate for Payer: First Choice Health Commercial |
$31.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.63
|
| Rate for Payer: HealthUtah PPO |
$32.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.80
|
| Rate for Payer: Multiplan Medicare/VA |
$20.55
|
| Rate for Payer: One Health Plan of WY PPO |
$32.12
|
| Rate for Payer: PacificSource Commercial |
$29.50
|
| Rate for Payer: PHCS PPO |
$32.12
|
| Rate for Payer: Three Rivers PPO |
$24.58
|
| Rate for Payer: TriWest Veterans Administration |
$21.63
|
| Rate for Payer: United Healthcare Commercial |
$28.52
|
| Rate for Payer: United Healthcare Medicare |
$21.63
|
| Rate for Payer: WINHealth Partners Commercial |
$31.14
|
| Rate for Payer: Wise Provider Network Commercial |
$31.14
|
|
