|
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
|
|
|
SUT VICRYL PLUS 0 SH 27"
|
Facility
|
IP
|
$4.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.60
|
| Rate for Payer: Altius Commercial |
$4.60
|
| Rate for Payer: Beech Street Commercial |
$4.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.93
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.65
|
| Rate for Payer: Cigna of WY Commercial |
$4.69
|
| Rate for Payer: Entrust Commercial |
$4.55
|
| Rate for Payer: First Choice Health Commercial |
$4.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.16
|
| Rate for Payer: HealthUtah PPO |
$4.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.65
|
| Rate for Payer: Multiplan Medicare/VA |
$3.00
|
| Rate for Payer: One Health Plan of WY PPO |
$4.69
|
| Rate for Payer: PacificSource Commercial |
$4.31
|
| Rate for Payer: PHCS PPO |
$4.69
|
| Rate for Payer: Three Rivers PPO |
$3.59
|
| Rate for Payer: TriWest Veterans Administration |
$3.16
|
| Rate for Payer: United Healthcare Commercial |
$4.17
|
| Rate for Payer: United Healthcare Medicare |
$3.16
|
| Rate for Payer: WINHealth Partners Commercial |
$4.55
|
| Rate for Payer: Wise Provider Network Commercial |
$4.55
|
|
|
SUT VICRYL PLUS 0 SH 27"
|
Facility
|
OP
|
$4.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.69
|
| Rate for Payer: Aetna of WY Medicare |
$3.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.60
|
| Rate for Payer: Altius Commercial |
$4.60
|
| Rate for Payer: Beech Street Commercial |
$4.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.93
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.65
|
| Rate for Payer: Cigna of WY Commercial |
$4.69
|
| Rate for Payer: Entrust Commercial |
$4.55
|
| Rate for Payer: First Choice Health Commercial |
$4.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.78
|
| Rate for Payer: HealthUtah PPO |
$4.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2.64
|
| Rate for Payer: One Health Plan of WY PPO |
$4.69
|
| Rate for Payer: PacificSource Commercial |
$4.31
|
| Rate for Payer: PHCS PPO |
$4.69
|
| Rate for Payer: Three Rivers PPO |
$3.59
|
| Rate for Payer: TriWest Veterans Administration |
$2.78
|
| Rate for Payer: United Healthcare Commercial |
$4.17
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4.69
|
| Rate for Payer: Wise Provider Network Commercial |
$4.55
|
|
|
SUT VICRYL PLUS 0 UR-6 27"
|
Facility
|
OP
|
$5.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.71
|
| Rate for Payer: Aetna of WY Medicare |
$3.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.60
|
| Rate for Payer: Altius Commercial |
$5.60
|
| Rate for Payer: Beech Street Commercial |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.66
|
| Rate for Payer: Cigna of WY Commercial |
$5.71
|
| Rate for Payer: Entrust Commercial |
$5.54
|
| Rate for Payer: First Choice Health Commercial |
$5.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.38
|
| Rate for Payer: HealthUtah PPO |
$5.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.66
|
| Rate for Payer: Multiplan Medicare/VA |
$3.21
|
| Rate for Payer: One Health Plan of WY PPO |
$5.71
|
| Rate for Payer: PacificSource Commercial |
$5.25
|
| Rate for Payer: PHCS PPO |
$5.71
|
| Rate for Payer: Three Rivers PPO |
$4.37
|
| Rate for Payer: TriWest Veterans Administration |
$3.38
|
| Rate for Payer: United Healthcare Commercial |
$5.07
|
| Rate for Payer: United Healthcare Medicare |
$3.38
|
| Rate for Payer: WINHealth Partners Commercial |
$5.71
|
| Rate for Payer: Wise Provider Network Commercial |
$5.54
|
|
|
SUT VICRYL PLUS 0 UR-6 27"
|
Facility
|
IP
|
$5.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.60
|
| Rate for Payer: Altius Commercial |
$5.60
|
| Rate for Payer: Beech Street Commercial |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.66
|
| Rate for Payer: Cigna of WY Commercial |
$5.71
|
| Rate for Payer: Entrust Commercial |
$5.54
|
| Rate for Payer: First Choice Health Commercial |
$5.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.85
|
| Rate for Payer: HealthUtah PPO |
$5.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.66
|
| Rate for Payer: Multiplan Medicare/VA |
$3.66
|
| Rate for Payer: One Health Plan of WY PPO |
$5.71
|
| Rate for Payer: PacificSource Commercial |
$5.25
|
| Rate for Payer: PHCS PPO |
$5.71
|
| Rate for Payer: Three Rivers PPO |
$4.37
|
| Rate for Payer: TriWest Veterans Administration |
$3.85
|
| Rate for Payer: United Healthcare Commercial |
$5.07
|
| Rate for Payer: United Healthcare Medicare |
$3.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5.54
|
| Rate for Payer: Wise Provider Network Commercial |
$5.54
|
|
|
SUT VICRYL PLUS 1 18" CT-1 CR
|
Facility
|
OP
|
$32.68
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$32.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.03
|
| Rate for Payer: Aetna of WY Medicare |
$21.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.37
|
| Rate for Payer: Altius Commercial |
$31.37
|
| Rate for Payer: Beech Street Commercial |
$32.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.83
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.70
|
| Rate for Payer: Cigna of WY Commercial |
$32.03
|
| Rate for Payer: Entrust Commercial |
$31.05
|
| Rate for Payer: First Choice Health Commercial |
$31.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.95
|
| Rate for Payer: HealthUtah PPO |
$32.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.70
|
| Rate for Payer: Multiplan Medicare/VA |
$18.01
|
| Rate for Payer: One Health Plan of WY PPO |
$32.03
|
| Rate for Payer: PacificSource Commercial |
$29.41
|
| Rate for Payer: PHCS PPO |
$32.03
|
| Rate for Payer: Three Rivers PPO |
$24.51
|
| Rate for Payer: TriWest Veterans Administration |
$18.95
|
| Rate for Payer: United Healthcare Commercial |
$28.43
|
| Rate for Payer: United Healthcare Medicare |
$18.95
|
| Rate for Payer: WINHealth Partners Commercial |
$32.03
|
| Rate for Payer: Wise Provider Network Commercial |
$31.05
|
|
|
SUT VICRYL PLUS 1 18" CT-1 CR
|
Facility
|
IP
|
$32.68
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$32.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.37
|
| Rate for Payer: Altius Commercial |
$31.37
|
| Rate for Payer: Beech Street Commercial |
$32.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.83
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.70
|
| Rate for Payer: Cigna of WY Commercial |
$32.03
|
| Rate for Payer: Entrust Commercial |
$31.05
|
| Rate for Payer: First Choice Health Commercial |
$31.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.57
|
| Rate for Payer: HealthUtah PPO |
$32.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.70
|
| Rate for Payer: Multiplan Medicare/VA |
$20.49
|
| Rate for Payer: One Health Plan of WY PPO |
$32.03
|
| Rate for Payer: PacificSource Commercial |
$29.41
|
| Rate for Payer: PHCS PPO |
$32.03
|
| Rate for Payer: Three Rivers PPO |
$24.51
|
| Rate for Payer: TriWest Veterans Administration |
$21.57
|
| Rate for Payer: United Healthcare Commercial |
$28.43
|
| Rate for Payer: United Healthcare Medicare |
$21.57
|
| Rate for Payer: WINHealth Partners Commercial |
$31.05
|
| Rate for Payer: Wise Provider Network Commercial |
$31.05
|
|
|
SUT VICRYL PLUS 1 36" CTX
|
Facility
|
IP
|
$5.26
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.05
|
| Rate for Payer: Altius Commercial |
$5.05
|
| Rate for Payer: Beech Street Commercial |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.32
|
| Rate for Payer: Cash Price |
$3.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.10
|
| Rate for Payer: Cigna of WY Commercial |
$5.15
|
| Rate for Payer: Entrust Commercial |
$5.00
|
| Rate for Payer: First Choice Health Commercial |
$5.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.47
|
| Rate for Payer: HealthUtah PPO |
$5.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.10
|
| Rate for Payer: Multiplan Medicare/VA |
$3.30
|
| Rate for Payer: One Health Plan of WY PPO |
$5.15
|
| Rate for Payer: PacificSource Commercial |
$4.73
|
| Rate for Payer: PHCS PPO |
$5.15
|
| Rate for Payer: Three Rivers PPO |
$3.94
|
| Rate for Payer: TriWest Veterans Administration |
$3.47
|
| Rate for Payer: United Healthcare Commercial |
$4.58
|
| Rate for Payer: United Healthcare Medicare |
$3.47
|
| Rate for Payer: WINHealth Partners Commercial |
$5.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5.00
|
|
|
SUT VICRYL PLUS 1 36" CTX
|
Facility
|
OP
|
$5.26
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$5.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.15
|
| Rate for Payer: Aetna of WY Medicare |
$3.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.05
|
| Rate for Payer: Altius Commercial |
$5.05
|
| Rate for Payer: Beech Street Commercial |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.32
|
| Rate for Payer: Cash Price |
$3.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.10
|
| Rate for Payer: Cigna of WY Commercial |
$5.15
|
| Rate for Payer: Entrust Commercial |
$5.00
|
| Rate for Payer: First Choice Health Commercial |
$5.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.05
|
| Rate for Payer: HealthUtah PPO |
$5.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2.90
|
| Rate for Payer: One Health Plan of WY PPO |
$5.15
|
| Rate for Payer: PacificSource Commercial |
$4.73
|
| Rate for Payer: PHCS PPO |
$5.15
|
| Rate for Payer: Three Rivers PPO |
$3.94
|
| Rate for Payer: TriWest Veterans Administration |
$3.05
|
| Rate for Payer: United Healthcare Commercial |
$4.58
|
| Rate for Payer: United Healthcare Medicare |
$3.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5.15
|
| Rate for Payer: Wise Provider Network Commercial |
$5.00
|
|
|
SUT VICRYL PLUS 1 CP-1
|
Facility
|
IP
|
$5.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.94
|
| Rate for Payer: Altius Commercial |
$4.94
|
| Rate for Payer: Beech Street Commercial |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.00
|
| Rate for Payer: Cigna of WY Commercial |
$5.05
|
| Rate for Payer: Entrust Commercial |
$4.89
|
| Rate for Payer: First Choice Health Commercial |
$4.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.40
|
| Rate for Payer: HealthUtah PPO |
$5.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3.23
|
| Rate for Payer: One Health Plan of WY PPO |
$5.05
|
| Rate for Payer: PacificSource Commercial |
$4.64
|
| Rate for Payer: PHCS PPO |
$5.05
|
| Rate for Payer: Three Rivers PPO |
$3.86
|
| Rate for Payer: TriWest Veterans Administration |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$4.48
|
| Rate for Payer: United Healthcare Medicare |
$3.40
|
| Rate for Payer: WINHealth Partners Commercial |
$4.89
|
| Rate for Payer: Wise Provider Network Commercial |
$4.89
|
|
|
SUT VICRYL PLUS 1 CP-1
|
Facility
|
OP
|
$5.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$5.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.05
|
| Rate for Payer: Aetna of WY Medicare |
$3.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.94
|
| Rate for Payer: Altius Commercial |
$4.94
|
| Rate for Payer: Beech Street Commercial |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.00
|
| Rate for Payer: Cigna of WY Commercial |
$5.05
|
| Rate for Payer: Entrust Commercial |
$4.89
|
| Rate for Payer: First Choice Health Commercial |
$4.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.99
|
| Rate for Payer: HealthUtah PPO |
$5.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2.84
|
| Rate for Payer: One Health Plan of WY PPO |
$5.05
|
| Rate for Payer: PacificSource Commercial |
$4.64
|
| Rate for Payer: PHCS PPO |
$5.05
|
| Rate for Payer: Three Rivers PPO |
$3.86
|
| Rate for Payer: TriWest Veterans Administration |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$4.48
|
| Rate for Payer: United Healthcare Medicare |
$2.99
|
| Rate for Payer: WINHealth Partners Commercial |
$5.05
|
| Rate for Payer: Wise Provider Network Commercial |
$4.89
|
|
|
SUT VICRYL PLUS 2-0 36" CT-1
|
Facility
|
OP
|
$5.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.98
|
| Rate for Payer: Aetna of WY Medicare |
$3.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.88
|
| Rate for Payer: Altius Commercial |
$4.88
|
| Rate for Payer: Beech Street Commercial |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.93
|
| Rate for Payer: Cigna of WY Commercial |
$4.98
|
| Rate for Payer: Entrust Commercial |
$4.83
|
| Rate for Payer: First Choice Health Commercial |
$4.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.95
|
| Rate for Payer: HealthUtah PPO |
$5.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.93
|
| Rate for Payer: Multiplan Medicare/VA |
$2.80
|
| Rate for Payer: One Health Plan of WY PPO |
$4.98
|
| Rate for Payer: PacificSource Commercial |
$4.57
|
| Rate for Payer: PHCS PPO |
$4.98
|
| Rate for Payer: Three Rivers PPO |
$3.81
|
| Rate for Payer: TriWest Veterans Administration |
$2.95
|
| Rate for Payer: United Healthcare Commercial |
$4.42
|
| Rate for Payer: United Healthcare Medicare |
$2.95
|
| Rate for Payer: WINHealth Partners Commercial |
$4.98
|
| Rate for Payer: Wise Provider Network Commercial |
$4.83
|
|
|
SUT VICRYL PLUS 2-0 36" CT-1
|
Facility
|
IP
|
$5.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.88
|
| Rate for Payer: Altius Commercial |
$4.88
|
| Rate for Payer: Beech Street Commercial |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.93
|
| Rate for Payer: Cigna of WY Commercial |
$4.98
|
| Rate for Payer: Entrust Commercial |
$4.83
|
| Rate for Payer: First Choice Health Commercial |
$4.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.35
|
| Rate for Payer: HealthUtah PPO |
$5.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.93
|
| Rate for Payer: Multiplan Medicare/VA |
$3.19
|
| Rate for Payer: One Health Plan of WY PPO |
$4.98
|
| Rate for Payer: PacificSource Commercial |
$4.57
|
| Rate for Payer: PHCS PPO |
$4.98
|
| Rate for Payer: Three Rivers PPO |
$3.81
|
| Rate for Payer: TriWest Veterans Administration |
$3.35
|
| Rate for Payer: United Healthcare Commercial |
$4.42
|
| Rate for Payer: United Healthcare Medicare |
$3.35
|
| Rate for Payer: WINHealth Partners Commercial |
$4.83
|
| Rate for Payer: Wise Provider Network Commercial |
$4.83
|
|
|
SUT VICRYL PLUS 2-0 CP-1 27"
|
Facility
|
IP
|
$5.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.92
|
| Rate for Payer: Altius Commercial |
$4.92
|
| Rate for Payer: Beech Street Commercial |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.97
|
| Rate for Payer: Cigna of WY Commercial |
$5.02
|
| Rate for Payer: Entrust Commercial |
$4.86
|
| Rate for Payer: First Choice Health Commercial |
$4.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.38
|
| Rate for Payer: HealthUtah PPO |
$5.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.97
|
| Rate for Payer: Multiplan Medicare/VA |
$3.21
|
| Rate for Payer: One Health Plan of WY PPO |
$5.02
|
| Rate for Payer: PacificSource Commercial |
$4.61
|
| Rate for Payer: PHCS PPO |
$5.02
|
| Rate for Payer: Three Rivers PPO |
$3.84
|
| Rate for Payer: TriWest Veterans Administration |
$3.38
|
| Rate for Payer: United Healthcare Commercial |
$4.45
|
| Rate for Payer: United Healthcare Medicare |
$3.38
|
| Rate for Payer: WINHealth Partners Commercial |
$4.86
|
| Rate for Payer: Wise Provider Network Commercial |
$4.86
|
|
|
SUT VICRYL PLUS 2-0 CP-1 27"
|
Facility
|
OP
|
$5.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.02
|
| Rate for Payer: Aetna of WY Medicare |
$3.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.92
|
| Rate for Payer: Altius Commercial |
$4.92
|
| Rate for Payer: Beech Street Commercial |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.97
|
| Rate for Payer: Cigna of WY Commercial |
$5.02
|
| Rate for Payer: Entrust Commercial |
$4.86
|
| Rate for Payer: First Choice Health Commercial |
$4.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.97
|
| Rate for Payer: HealthUtah PPO |
$5.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.97
|
| Rate for Payer: Multiplan Medicare/VA |
$2.82
|
| Rate for Payer: One Health Plan of WY PPO |
$5.02
|
| Rate for Payer: PacificSource Commercial |
$4.61
|
| Rate for Payer: PHCS PPO |
$5.02
|
| Rate for Payer: Three Rivers PPO |
$3.84
|
| Rate for Payer: TriWest Veterans Administration |
$2.97
|
| Rate for Payer: United Healthcare Commercial |
$4.45
|
| Rate for Payer: United Healthcare Medicare |
$2.97
|
| Rate for Payer: WINHealth Partners Commercial |
$5.02
|
| Rate for Payer: Wise Provider Network Commercial |
$4.86
|
|
|
SUT VICRYL PLUS 2-0 CP-2 18" 8PK
|
Facility
|
IP
|
$41.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$41.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.09
|
| Rate for Payer: Altius Commercial |
$40.09
|
| Rate for Payer: Beech Street Commercial |
$40.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.28
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.51
|
| Rate for Payer: Cigna of WY Commercial |
$40.92
|
| Rate for Payer: Entrust Commercial |
$39.67
|
| Rate for Payer: First Choice Health Commercial |
$39.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.56
|
| Rate for Payer: HealthUtah PPO |
$41.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.51
|
| Rate for Payer: Multiplan Medicare/VA |
$26.18
|
| Rate for Payer: One Health Plan of WY PPO |
$40.92
|
| Rate for Payer: PacificSource Commercial |
$37.58
|
| Rate for Payer: PHCS PPO |
$40.92
|
| Rate for Payer: Three Rivers PPO |
$31.32
|
| Rate for Payer: TriWest Veterans Administration |
$27.56
|
| Rate for Payer: United Healthcare Commercial |
$36.33
|
| Rate for Payer: United Healthcare Medicare |
$27.56
|
| Rate for Payer: WINHealth Partners Commercial |
$39.67
|
| Rate for Payer: Wise Provider Network Commercial |
$39.67
|
|
|
SUT VICRYL PLUS 2-0 CP-2 18" 8PK
|
Facility
|
OP
|
$41.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$41.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.92
|
| Rate for Payer: Aetna of WY Medicare |
$27.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.09
|
| Rate for Payer: Altius Commercial |
$40.09
|
| Rate for Payer: Beech Street Commercial |
$40.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.28
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.51
|
| Rate for Payer: Cigna of WY Commercial |
$40.92
|
| Rate for Payer: Entrust Commercial |
$39.67
|
| Rate for Payer: First Choice Health Commercial |
$39.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.22
|
| Rate for Payer: HealthUtah PPO |
$41.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.51
|
| Rate for Payer: Multiplan Medicare/VA |
$23.01
|
| Rate for Payer: One Health Plan of WY PPO |
$40.92
|
| Rate for Payer: PacificSource Commercial |
$37.58
|
| Rate for Payer: PHCS PPO |
$40.92
|
| Rate for Payer: Three Rivers PPO |
$31.32
|
| Rate for Payer: TriWest Veterans Administration |
$24.22
|
| Rate for Payer: United Healthcare Commercial |
$36.33
|
| Rate for Payer: United Healthcare Medicare |
$24.22
|
| Rate for Payer: WINHealth Partners Commercial |
$40.92
|
| Rate for Payer: Wise Provider Network Commercial |
$39.67
|
|
|
SUT VICRYL PLUS 2-0 CT 18" 8PK
|
Facility
|
IP
|
$32.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$32.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.48
|
| Rate for Payer: Altius Commercial |
$31.48
|
| Rate for Payer: Beech Street Commercial |
$32.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.92
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.81
|
| Rate for Payer: Cigna of WY Commercial |
$32.13
|
| Rate for Payer: Entrust Commercial |
$31.15
|
| Rate for Payer: First Choice Health Commercial |
$31.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.64
|
| Rate for Payer: HealthUtah PPO |
$32.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.81
|
| Rate for Payer: Multiplan Medicare/VA |
$20.56
|
| Rate for Payer: One Health Plan of WY PPO |
$32.13
|
| Rate for Payer: PacificSource Commercial |
$29.51
|
| Rate for Payer: PHCS PPO |
$32.13
|
| Rate for Payer: Three Rivers PPO |
$24.59
|
| Rate for Payer: TriWest Veterans Administration |
$21.64
|
| Rate for Payer: United Healthcare Commercial |
$28.53
|
| Rate for Payer: United Healthcare Medicare |
$21.64
|
| Rate for Payer: WINHealth Partners Commercial |
$31.15
|
| Rate for Payer: Wise Provider Network Commercial |
$31.15
|
|
|
SUT VICRYL PLUS 2-0 CT 18" 8PK
|
Facility
|
OP
|
$32.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$32.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.13
|
| Rate for Payer: Aetna of WY Medicare |
$21.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.48
|
| Rate for Payer: Altius Commercial |
$31.48
|
| Rate for Payer: Beech Street Commercial |
$32.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.92
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.81
|
| Rate for Payer: Cigna of WY Commercial |
$32.13
|
| Rate for Payer: Entrust Commercial |
$31.15
|
| Rate for Payer: First Choice Health Commercial |
$31.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.02
|
| Rate for Payer: HealthUtah PPO |
$32.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.81
|
| Rate for Payer: Multiplan Medicare/VA |
$18.07
|
| Rate for Payer: One Health Plan of WY PPO |
$32.13
|
| Rate for Payer: PacificSource Commercial |
$29.51
|
| Rate for Payer: PHCS PPO |
$32.13
|
| Rate for Payer: Three Rivers PPO |
$24.59
|
| Rate for Payer: TriWest Veterans Administration |
$19.02
|
| Rate for Payer: United Healthcare Commercial |
$28.53
|
| Rate for Payer: United Healthcare Medicare |
$19.02
|
| Rate for Payer: WINHealth Partners Commercial |
$32.13
|
| Rate for Payer: Wise Provider Network Commercial |
$31.15
|
|
|
SUT VICRYL PLUS 2-0 CT-2 27"
|
Facility
|
OP
|
$4.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.82
|
| Rate for Payer: Aetna of WY Medicare |
$3.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.72
|
| Rate for Payer: Altius Commercial |
$4.72
|
| Rate for Payer: Beech Street Commercial |
$4.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.04
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.77
|
| Rate for Payer: Cigna of WY Commercial |
$4.82
|
| Rate for Payer: Entrust Commercial |
$4.67
|
| Rate for Payer: First Choice Health Commercial |
$4.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.85
|
| Rate for Payer: HealthUtah PPO |
$4.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.77
|
| Rate for Payer: Multiplan Medicare/VA |
$2.71
|
| Rate for Payer: One Health Plan of WY PPO |
$4.82
|
| Rate for Payer: PacificSource Commercial |
$4.43
|
| Rate for Payer: PHCS PPO |
$4.82
|
| Rate for Payer: Three Rivers PPO |
$3.69
|
| Rate for Payer: TriWest Veterans Administration |
$2.85
|
| Rate for Payer: United Healthcare Commercial |
$4.28
|
| Rate for Payer: United Healthcare Medicare |
$2.85
|
| Rate for Payer: WINHealth Partners Commercial |
$4.82
|
| Rate for Payer: Wise Provider Network Commercial |
$4.67
|
|
|
SUT VICRYL PLUS 2-0 CT-2 27"
|
Facility
|
IP
|
$4.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.72
|
| Rate for Payer: Altius Commercial |
$4.72
|
| Rate for Payer: Beech Street Commercial |
$4.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.04
|
| Rate for Payer: Cash Price |
$3.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.77
|
| Rate for Payer: Cigna of WY Commercial |
$4.82
|
| Rate for Payer: Entrust Commercial |
$4.67
|
| Rate for Payer: First Choice Health Commercial |
$4.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.25
|
| Rate for Payer: HealthUtah PPO |
$4.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.77
|
| Rate for Payer: Multiplan Medicare/VA |
$3.08
|
| Rate for Payer: One Health Plan of WY PPO |
$4.82
|
| Rate for Payer: PacificSource Commercial |
$4.43
|
| Rate for Payer: PHCS PPO |
$4.82
|
| Rate for Payer: Three Rivers PPO |
$3.69
|
| Rate for Payer: TriWest Veterans Administration |
$3.25
|
| Rate for Payer: United Healthcare Commercial |
$4.28
|
| Rate for Payer: United Healthcare Medicare |
$3.25
|
| Rate for Payer: WINHealth Partners Commercial |
$4.67
|
| Rate for Payer: Wise Provider Network Commercial |
$4.67
|
|
|
SUT VICRYL PLUS 2-0 SH 27"
|
Facility
|
OP
|
$4.37
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.28
|
| Rate for Payer: Aetna of WY Medicare |
$2.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.20
|
| Rate for Payer: Altius Commercial |
$4.20
|
| Rate for Payer: Beech Street Commercial |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.24
|
| Rate for Payer: Cigna of WY Commercial |
$4.28
|
| Rate for Payer: Entrust Commercial |
$4.15
|
| Rate for Payer: First Choice Health Commercial |
$4.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.53
|
| Rate for Payer: HealthUtah PPO |
$4.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.24
|
| Rate for Payer: Multiplan Medicare/VA |
$2.41
|
| Rate for Payer: One Health Plan of WY PPO |
$4.28
|
| Rate for Payer: PacificSource Commercial |
$3.93
|
| Rate for Payer: PHCS PPO |
$4.28
|
| Rate for Payer: Three Rivers PPO |
$3.28
|
| Rate for Payer: TriWest Veterans Administration |
$2.53
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$2.53
|
| Rate for Payer: WINHealth Partners Commercial |
$4.28
|
| Rate for Payer: Wise Provider Network Commercial |
$4.15
|
|
|
SUT VICRYL PLUS 2-0 SH 27"
|
Facility
|
IP
|
$4.37
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.20
|
| Rate for Payer: Altius Commercial |
$4.20
|
| Rate for Payer: Beech Street Commercial |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.24
|
| Rate for Payer: Cigna of WY Commercial |
$4.28
|
| Rate for Payer: Entrust Commercial |
$4.15
|
| Rate for Payer: First Choice Health Commercial |
$4.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.88
|
| Rate for Payer: HealthUtah PPO |
$4.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.24
|
| Rate for Payer: Multiplan Medicare/VA |
$2.74
|
| Rate for Payer: One Health Plan of WY PPO |
$4.28
|
| Rate for Payer: PacificSource Commercial |
$3.93
|
| Rate for Payer: PHCS PPO |
$4.28
|
| Rate for Payer: Three Rivers PPO |
$3.28
|
| Rate for Payer: TriWest Veterans Administration |
$2.88
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$2.88
|
| Rate for Payer: WINHealth Partners Commercial |
$4.15
|
| Rate for Payer: Wise Provider Network Commercial |
$4.15
|
|
|
SUT VICRYL PLUS 2-0 TIE 18"
|
Facility
|
OP
|
$12.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$12.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.09
|
| Rate for Payer: Aetna of WY Medicare |
$8.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.85
|
| Rate for Payer: Altius Commercial |
$11.85
|
| Rate for Payer: Beech Street Commercial |
$12.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.13
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.97
|
| Rate for Payer: Cigna of WY Commercial |
$12.09
|
| Rate for Payer: Entrust Commercial |
$11.72
|
| Rate for Payer: First Choice Health Commercial |
$11.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.16
|
| Rate for Payer: HealthUtah PPO |
$12.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.97
|
| Rate for Payer: Multiplan Medicare/VA |
$6.80
|
| Rate for Payer: One Health Plan of WY PPO |
$12.09
|
| Rate for Payer: PacificSource Commercial |
$11.11
|
| Rate for Payer: PHCS PPO |
$12.09
|
| Rate for Payer: Three Rivers PPO |
$9.26
|
| Rate for Payer: TriWest Veterans Administration |
$7.16
|
| Rate for Payer: United Healthcare Commercial |
$10.74
|
| Rate for Payer: United Healthcare Medicare |
$7.16
|
| Rate for Payer: WINHealth Partners Commercial |
$12.09
|
| Rate for Payer: Wise Provider Network Commercial |
$11.72
|
|
|
SUT VICRYL PLUS 2-0 TIE 18"
|
Facility
|
IP
|
$12.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$12.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.85
|
| Rate for Payer: Altius Commercial |
$11.85
|
| Rate for Payer: Beech Street Commercial |
$12.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.13
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.97
|
| Rate for Payer: Cigna of WY Commercial |
$12.09
|
| Rate for Payer: Entrust Commercial |
$11.72
|
| Rate for Payer: First Choice Health Commercial |
$11.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.14
|
| Rate for Payer: HealthUtah PPO |
$12.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.97
|
| Rate for Payer: Multiplan Medicare/VA |
$7.74
|
| Rate for Payer: One Health Plan of WY PPO |
$12.09
|
| Rate for Payer: PacificSource Commercial |
$11.11
|
| Rate for Payer: PHCS PPO |
$12.09
|
| Rate for Payer: Three Rivers PPO |
$9.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.14
|
| Rate for Payer: United Healthcare Commercial |
$10.74
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WINHealth Partners Commercial |
$11.72
|
| Rate for Payer: Wise Provider Network Commercial |
$11.72
|
|
