|
SUT VICRYL PLUS 3-0 CT-1 36"
|
Facility
|
OP
|
$5.06
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.96
|
| Rate for Payer: Aetna of WY Medicare |
$3.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.86
|
| Rate for Payer: Altius Commercial |
$4.86
|
| Rate for Payer: Beech Street Commercial |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.91
|
| Rate for Payer: Cigna of WY Commercial |
$4.96
|
| Rate for Payer: Entrust Commercial |
$4.81
|
| Rate for Payer: First Choice Health Commercial |
$4.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.93
|
| Rate for Payer: HealthUtah PPO |
$5.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.91
|
| Rate for Payer: Multiplan Medicare/VA |
$2.79
|
| Rate for Payer: One Health Plan of WY PPO |
$4.96
|
| Rate for Payer: PacificSource Commercial |
$4.55
|
| Rate for Payer: PHCS PPO |
$4.96
|
| Rate for Payer: Three Rivers PPO |
$3.80
|
| Rate for Payer: TriWest Veterans Administration |
$2.93
|
| Rate for Payer: United Healthcare Commercial |
$4.40
|
| Rate for Payer: United Healthcare Medicare |
$2.93
|
| Rate for Payer: WINHealth Partners Commercial |
$4.96
|
| Rate for Payer: Wise Provider Network Commercial |
$4.81
|
|
|
SUT VICRYL PLUS 3-0 CT-1 36"
|
Facility
|
IP
|
$5.06
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.86
|
| Rate for Payer: Altius Commercial |
$4.86
|
| Rate for Payer: Beech Street Commercial |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.91
|
| Rate for Payer: Cigna of WY Commercial |
$4.96
|
| Rate for Payer: Entrust Commercial |
$4.81
|
| Rate for Payer: First Choice Health Commercial |
$4.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.34
|
| Rate for Payer: HealthUtah PPO |
$5.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.91
|
| Rate for Payer: Multiplan Medicare/VA |
$3.17
|
| Rate for Payer: One Health Plan of WY PPO |
$4.96
|
| Rate for Payer: PacificSource Commercial |
$4.55
|
| Rate for Payer: PHCS PPO |
$4.96
|
| Rate for Payer: Three Rivers PPO |
$3.80
|
| Rate for Payer: TriWest Veterans Administration |
$3.34
|
| Rate for Payer: United Healthcare Commercial |
$4.40
|
| Rate for Payer: United Healthcare Medicare |
$3.34
|
| Rate for Payer: WINHealth Partners Commercial |
$4.81
|
| Rate for Payer: Wise Provider Network Commercial |
$4.81
|
|
|
SUT VICRYL PLUS 3-0 SH 18" 8PK
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.69 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.78
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$20.69
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$21.78
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$21.78
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
SUT VICRYL PLUS 3-0 SH 18" 8PK
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$21.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$31.68
|
| Rate for Payer: Altius Commercial |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$32.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.09
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: Entrust Commercial |
$31.35
|
| Rate for Payer: First Choice Health Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.14
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$32.34
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$19.14
|
| Rate for Payer: WINHealth Partners Commercial |
$32.34
|
| Rate for Payer: Wise Provider Network Commercial |
$31.35
|
|
|
SUT VICRYL PLUS 3-0 SH 27"
|
Facility
|
IP
|
$4.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.54
|
| Rate for Payer: Altius Commercial |
$4.54
|
| Rate for Payer: Beech Street Commercial |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.88
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.59
|
| Rate for Payer: Cigna of WY Commercial |
$4.64
|
| Rate for Payer: Entrust Commercial |
$4.49
|
| Rate for Payer: First Choice Health Commercial |
$4.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.12
|
| Rate for Payer: HealthUtah PPO |
$4.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.59
|
| Rate for Payer: Multiplan Medicare/VA |
$2.97
|
| Rate for Payer: One Health Plan of WY PPO |
$4.64
|
| Rate for Payer: PacificSource Commercial |
$4.26
|
| Rate for Payer: PHCS PPO |
$4.64
|
| Rate for Payer: Three Rivers PPO |
$3.55
|
| Rate for Payer: TriWest Veterans Administration |
$3.12
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
| Rate for Payer: WINHealth Partners Commercial |
$4.49
|
| Rate for Payer: Wise Provider Network Commercial |
$4.49
|
|
|
SUT VICRYL PLUS 3-0 SH 27"
|
Facility
|
OP
|
$4.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.64
|
| Rate for Payer: Aetna of WY Medicare |
$3.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.54
|
| Rate for Payer: Altius Commercial |
$4.54
|
| Rate for Payer: Beech Street Commercial |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.88
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.59
|
| Rate for Payer: Cigna of WY Commercial |
$4.64
|
| Rate for Payer: Entrust Commercial |
$4.49
|
| Rate for Payer: First Choice Health Commercial |
$4.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.74
|
| Rate for Payer: HealthUtah PPO |
$4.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.59
|
| Rate for Payer: Multiplan Medicare/VA |
$2.61
|
| Rate for Payer: One Health Plan of WY PPO |
$4.64
|
| Rate for Payer: PacificSource Commercial |
$4.26
|
| Rate for Payer: PHCS PPO |
$4.64
|
| Rate for Payer: Three Rivers PPO |
$3.55
|
| Rate for Payer: TriWest Veterans Administration |
$2.74
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare |
$2.74
|
| Rate for Payer: WINHealth Partners Commercial |
$4.64
|
| Rate for Payer: Wise Provider Network Commercial |
$4.49
|
|
|
SUT VICRYL PLUS 4-0 PS-2 27"
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.52
|
| Rate for Payer: Altius Commercial |
$11.52
|
| Rate for Payer: Beech Street Commercial |
$11.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.64
|
| Rate for Payer: Cigna of WY Commercial |
$11.76
|
| Rate for Payer: Entrust Commercial |
$11.40
|
| Rate for Payer: First Choice Health Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.92
|
| Rate for Payer: HealthUtah PPO |
$12.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.64
|
| Rate for Payer: Multiplan Medicare/VA |
$7.52
|
| Rate for Payer: One Health Plan of WY PPO |
$11.76
|
| Rate for Payer: PacificSource Commercial |
$10.80
|
| Rate for Payer: PHCS PPO |
$11.76
|
| Rate for Payer: Three Rivers PPO |
$9.00
|
| Rate for Payer: TriWest Veterans Administration |
$7.92
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
| Rate for Payer: United Healthcare Medicare |
$7.92
|
| Rate for Payer: WINHealth Partners Commercial |
$11.40
|
| Rate for Payer: Wise Provider Network Commercial |
$11.40
|
|
|
SUT VICRYL PLUS 4-0 PS-2 27"
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.76
|
| Rate for Payer: Aetna of WY Medicare |
$7.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.52
|
| Rate for Payer: Altius Commercial |
$11.52
|
| Rate for Payer: Beech Street Commercial |
$11.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.64
|
| Rate for Payer: Cigna of WY Commercial |
$11.76
|
| Rate for Payer: Entrust Commercial |
$11.40
|
| Rate for Payer: First Choice Health Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.96
|
| Rate for Payer: HealthUtah PPO |
$12.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.64
|
| Rate for Payer: Multiplan Medicare/VA |
$6.61
|
| Rate for Payer: One Health Plan of WY PPO |
$11.76
|
| Rate for Payer: PacificSource Commercial |
$10.80
|
| Rate for Payer: PHCS PPO |
$11.76
|
| Rate for Payer: Three Rivers PPO |
$9.00
|
| Rate for Payer: TriWest Veterans Administration |
$6.96
|
| Rate for Payer: United Healthcare Commercial |
$10.44
|
| Rate for Payer: United Healthcare Medicare |
$6.96
|
| Rate for Payer: WINHealth Partners Commercial |
$11.76
|
| Rate for Payer: Wise Provider Network Commercial |
$11.40
|
|
|
SUT VICRYL PLUS 4-0 SH 27"
|
Facility
|
IP
|
$4.87
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.68
|
| Rate for Payer: Altius Commercial |
$4.68
|
| Rate for Payer: Beech Street Commercial |
$4.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.72
|
| Rate for Payer: Cigna of WY Commercial |
$4.77
|
| Rate for Payer: Entrust Commercial |
$4.63
|
| Rate for Payer: First Choice Health Commercial |
$4.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.21
|
| Rate for Payer: HealthUtah PPO |
$4.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.72
|
| Rate for Payer: Multiplan Medicare/VA |
$3.05
|
| Rate for Payer: One Health Plan of WY PPO |
$4.77
|
| Rate for Payer: PacificSource Commercial |
$4.38
|
| Rate for Payer: PHCS PPO |
$4.77
|
| Rate for Payer: Three Rivers PPO |
$3.65
|
| Rate for Payer: TriWest Veterans Administration |
$3.21
|
| Rate for Payer: United Healthcare Commercial |
$4.24
|
| Rate for Payer: United Healthcare Medicare |
$3.21
|
| Rate for Payer: WINHealth Partners Commercial |
$4.63
|
| Rate for Payer: Wise Provider Network Commercial |
$4.63
|
|
|
SUT VICRYL PLUS 4-0 SH 27"
|
Facility
|
OP
|
$4.87
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.77
|
| Rate for Payer: Aetna of WY Medicare |
$3.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.68
|
| Rate for Payer: Altius Commercial |
$4.68
|
| Rate for Payer: Beech Street Commercial |
$4.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.72
|
| Rate for Payer: Cigna of WY Commercial |
$4.77
|
| Rate for Payer: Entrust Commercial |
$4.63
|
| Rate for Payer: First Choice Health Commercial |
$4.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.82
|
| Rate for Payer: HealthUtah PPO |
$4.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.72
|
| Rate for Payer: Multiplan Medicare/VA |
$2.68
|
| Rate for Payer: One Health Plan of WY PPO |
$4.77
|
| Rate for Payer: PacificSource Commercial |
$4.38
|
| Rate for Payer: PHCS PPO |
$4.77
|
| Rate for Payer: Three Rivers PPO |
$3.65
|
| Rate for Payer: TriWest Veterans Administration |
$2.82
|
| Rate for Payer: United Healthcare Commercial |
$4.24
|
| Rate for Payer: United Healthcare Medicare |
$2.82
|
| Rate for Payer: WINHealth Partners Commercial |
$4.77
|
| Rate for Payer: Wise Provider Network Commercial |
$4.63
|
|
|
SUT VICRYL PLUS 5-0 PS-5 18"
|
Facility
|
OP
|
$14.22
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.94
|
| Rate for Payer: Aetna of WY Medicare |
$9.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.65
|
| Rate for Payer: Altius Commercial |
$13.65
|
| Rate for Payer: Beech Street Commercial |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.67
|
| Rate for Payer: Cash Price |
$9.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.79
|
| Rate for Payer: Cigna of WY Commercial |
$13.94
|
| Rate for Payer: Entrust Commercial |
$13.51
|
| Rate for Payer: First Choice Health Commercial |
$13.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.25
|
| Rate for Payer: HealthUtah PPO |
$14.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.79
|
| Rate for Payer: Multiplan Medicare/VA |
$7.84
|
| Rate for Payer: One Health Plan of WY PPO |
$13.94
|
| Rate for Payer: PacificSource Commercial |
$12.80
|
| Rate for Payer: PHCS PPO |
$13.94
|
| Rate for Payer: Three Rivers PPO |
$10.66
|
| Rate for Payer: TriWest Veterans Administration |
$8.25
|
| Rate for Payer: United Healthcare Commercial |
$12.37
|
| Rate for Payer: United Healthcare Medicare |
$8.25
|
| Rate for Payer: WINHealth Partners Commercial |
$13.94
|
| Rate for Payer: Wise Provider Network Commercial |
$13.51
|
|
|
SUT VICRYL PLUS 5-0 PS-5 18"
|
Facility
|
IP
|
$14.22
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.65
|
| Rate for Payer: Altius Commercial |
$13.65
|
| Rate for Payer: Beech Street Commercial |
$13.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.67
|
| Rate for Payer: Cash Price |
$9.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.79
|
| Rate for Payer: Cigna of WY Commercial |
$13.94
|
| Rate for Payer: Entrust Commercial |
$13.51
|
| Rate for Payer: First Choice Health Commercial |
$13.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.39
|
| Rate for Payer: HealthUtah PPO |
$14.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.79
|
| Rate for Payer: Multiplan Medicare/VA |
$8.92
|
| Rate for Payer: One Health Plan of WY PPO |
$13.94
|
| Rate for Payer: PacificSource Commercial |
$12.80
|
| Rate for Payer: PHCS PPO |
$13.94
|
| Rate for Payer: Three Rivers PPO |
$10.66
|
| Rate for Payer: TriWest Veterans Administration |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$12.37
|
| Rate for Payer: United Healthcare Medicare |
$9.39
|
| Rate for Payer: WINHealth Partners Commercial |
$13.51
|
| Rate for Payer: Wise Provider Network Commercial |
$13.51
|
|
|
SUT VICRYL PLUS 5-0 RB-1 27"
|
Facility
|
IP
|
$4.78
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.59
|
| Rate for Payer: Altius Commercial |
$4.59
|
| Rate for Payer: Beech Street Commercial |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.64
|
| Rate for Payer: Cigna of WY Commercial |
$4.68
|
| Rate for Payer: Entrust Commercial |
$4.54
|
| Rate for Payer: First Choice Health Commercial |
$4.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.15
|
| Rate for Payer: HealthUtah PPO |
$4.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.64
|
| Rate for Payer: Multiplan Medicare/VA |
$3.00
|
| Rate for Payer: One Health Plan of WY PPO |
$4.68
|
| Rate for Payer: PacificSource Commercial |
$4.30
|
| Rate for Payer: PHCS PPO |
$4.68
|
| Rate for Payer: Three Rivers PPO |
$3.58
|
| Rate for Payer: TriWest Veterans Administration |
$3.15
|
| Rate for Payer: United Healthcare Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicare |
$3.15
|
| Rate for Payer: WINHealth Partners Commercial |
$4.54
|
| Rate for Payer: Wise Provider Network Commercial |
$4.54
|
|
|
SUT VICRYL PLUS 5-0 RB-1 27"
|
Facility
|
OP
|
$4.78
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.68
|
| Rate for Payer: Aetna of WY Medicare |
$3.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.59
|
| Rate for Payer: Altius Commercial |
$4.59
|
| Rate for Payer: Beech Street Commercial |
$4.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.92
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.64
|
| Rate for Payer: Cigna of WY Commercial |
$4.68
|
| Rate for Payer: Entrust Commercial |
$4.54
|
| Rate for Payer: First Choice Health Commercial |
$4.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.77
|
| Rate for Payer: HealthUtah PPO |
$4.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.64
|
| Rate for Payer: Multiplan Medicare/VA |
$2.63
|
| Rate for Payer: One Health Plan of WY PPO |
$4.68
|
| Rate for Payer: PacificSource Commercial |
$4.30
|
| Rate for Payer: PHCS PPO |
$4.68
|
| Rate for Payer: Three Rivers PPO |
$3.58
|
| Rate for Payer: TriWest Veterans Administration |
$2.77
|
| Rate for Payer: United Healthcare Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicare |
$2.77
|
| Rate for Payer: WINHealth Partners Commercial |
$4.68
|
| Rate for Payer: Wise Provider Network Commercial |
$4.54
|
|
|
SUT VLOC 180 0 9" GS-21
|
Facility
|
IP
|
$58.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$58.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.00
|
| Rate for Payer: Altius Commercial |
$56.00
|
| Rate for Payer: Beech Street Commercial |
$57.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.89
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.58
|
| Rate for Payer: Cigna of WY Commercial |
$57.16
|
| Rate for Payer: Entrust Commercial |
$55.41
|
| Rate for Payer: First Choice Health Commercial |
$55.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.50
|
| Rate for Payer: HealthUtah PPO |
$58.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.58
|
| Rate for Payer: Multiplan Medicare/VA |
$36.57
|
| Rate for Payer: One Health Plan of WY PPO |
$57.16
|
| Rate for Payer: PacificSource Commercial |
$52.50
|
| Rate for Payer: PHCS PPO |
$57.16
|
| Rate for Payer: Three Rivers PPO |
$43.75
|
| Rate for Payer: TriWest Veterans Administration |
$38.50
|
| Rate for Payer: United Healthcare Commercial |
$50.75
|
| Rate for Payer: United Healthcare Medicare |
$38.50
|
| Rate for Payer: WINHealth Partners Commercial |
$55.41
|
| Rate for Payer: Wise Provider Network Commercial |
$55.41
|
|
|
SUT VLOC 180 0 9" GS-21
|
Facility
|
OP
|
$58.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.14 |
| Max. Negotiated Rate |
$58.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.16
|
| Rate for Payer: Aetna of WY Medicare |
$38.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.00
|
| Rate for Payer: Altius Commercial |
$56.00
|
| Rate for Payer: Beech Street Commercial |
$57.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.89
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.58
|
| Rate for Payer: Cigna of WY Commercial |
$57.16
|
| Rate for Payer: Entrust Commercial |
$55.41
|
| Rate for Payer: First Choice Health Commercial |
$55.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.83
|
| Rate for Payer: HealthUtah PPO |
$58.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.58
|
| Rate for Payer: Multiplan Medicare/VA |
$32.14
|
| Rate for Payer: One Health Plan of WY PPO |
$57.16
|
| Rate for Payer: PacificSource Commercial |
$52.50
|
| Rate for Payer: PHCS PPO |
$57.16
|
| Rate for Payer: Three Rivers PPO |
$43.75
|
| Rate for Payer: TriWest Veterans Administration |
$33.83
|
| Rate for Payer: United Healthcare Commercial |
$50.75
|
| Rate for Payer: United Healthcare Medicare |
$33.83
|
| Rate for Payer: WINHealth Partners Commercial |
$57.16
|
| Rate for Payer: Wise Provider Network Commercial |
$55.41
|
|
|
SUT VLOC 180 2-0 12" GS-21
|
Facility
|
IP
|
$102.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$102.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.44
|
| Rate for Payer: Altius Commercial |
$98.44
|
| Rate for Payer: Beech Street Commercial |
$100.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.19
|
| Rate for Payer: Cash Price |
$71.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.46
|
| Rate for Payer: Cigna of WY Commercial |
$100.49
|
| Rate for Payer: Entrust Commercial |
$97.41
|
| Rate for Payer: First Choice Health Commercial |
$97.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.68
|
| Rate for Payer: HealthUtah PPO |
$102.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.46
|
| Rate for Payer: Multiplan Medicare/VA |
$64.29
|
| Rate for Payer: One Health Plan of WY PPO |
$100.49
|
| Rate for Payer: PacificSource Commercial |
$92.29
|
| Rate for Payer: PHCS PPO |
$100.49
|
| Rate for Payer: Three Rivers PPO |
$76.90
|
| Rate for Payer: TriWest Veterans Administration |
$67.68
|
| Rate for Payer: United Healthcare Commercial |
$89.21
|
| Rate for Payer: United Healthcare Medicare |
$67.68
|
| Rate for Payer: WINHealth Partners Commercial |
$97.41
|
| Rate for Payer: Wise Provider Network Commercial |
$97.41
|
|
|
SUT VLOC 180 2-0 12" GS-21
|
Facility
|
OP
|
$102.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$102.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.49
|
| Rate for Payer: Aetna of WY Medicare |
$67.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.44
|
| Rate for Payer: Altius Commercial |
$98.44
|
| Rate for Payer: Beech Street Commercial |
$100.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.19
|
| Rate for Payer: Cash Price |
$71.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.46
|
| Rate for Payer: Cigna of WY Commercial |
$100.49
|
| Rate for Payer: Entrust Commercial |
$97.41
|
| Rate for Payer: First Choice Health Commercial |
$97.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.47
|
| Rate for Payer: HealthUtah PPO |
$102.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.46
|
| Rate for Payer: Multiplan Medicare/VA |
$56.50
|
| Rate for Payer: One Health Plan of WY PPO |
$100.49
|
| Rate for Payer: PacificSource Commercial |
$92.29
|
| Rate for Payer: PHCS PPO |
$100.49
|
| Rate for Payer: Three Rivers PPO |
$76.90
|
| Rate for Payer: TriWest Veterans Administration |
$59.47
|
| Rate for Payer: United Healthcare Commercial |
$89.21
|
| Rate for Payer: United Healthcare Medicare |
$59.47
|
| Rate for Payer: WINHealth Partners Commercial |
$100.49
|
| Rate for Payer: Wise Provider Network Commercial |
$97.41
|
|
|
SUT VLOC 180 2-0 9" GS-22
|
Facility
|
IP
|
$97.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.23 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.74
|
| Rate for Payer: Altius Commercial |
$93.74
|
| Rate for Payer: Beech Street Commercial |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.17
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.72
|
| Rate for Payer: Cigna of WY Commercial |
$95.70
|
| Rate for Payer: Entrust Commercial |
$92.77
|
| Rate for Payer: First Choice Health Commercial |
$92.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.45
|
| Rate for Payer: HealthUtah PPO |
$97.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.72
|
| Rate for Payer: Multiplan Medicare/VA |
$61.23
|
| Rate for Payer: One Health Plan of WY PPO |
$95.70
|
| Rate for Payer: PacificSource Commercial |
$87.88
|
| Rate for Payer: PHCS PPO |
$95.70
|
| Rate for Payer: Three Rivers PPO |
$73.24
|
| Rate for Payer: TriWest Veterans Administration |
$64.45
|
| Rate for Payer: United Healthcare Commercial |
$84.96
|
| Rate for Payer: United Healthcare Medicare |
$64.45
|
| Rate for Payer: WINHealth Partners Commercial |
$92.77
|
| Rate for Payer: Wise Provider Network Commercial |
$92.77
|
|
|
SUT VLOC 180 2-0 9" GS-22
|
Facility
|
OP
|
$97.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.81 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.70
|
| Rate for Payer: Aetna of WY Medicare |
$64.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.74
|
| Rate for Payer: Altius Commercial |
$93.74
|
| Rate for Payer: Beech Street Commercial |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.17
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.72
|
| Rate for Payer: Cigna of WY Commercial |
$95.70
|
| Rate for Payer: Entrust Commercial |
$92.77
|
| Rate for Payer: First Choice Health Commercial |
$92.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.64
|
| Rate for Payer: HealthUtah PPO |
$97.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.72
|
| Rate for Payer: Multiplan Medicare/VA |
$53.81
|
| Rate for Payer: One Health Plan of WY PPO |
$95.70
|
| Rate for Payer: PacificSource Commercial |
$87.88
|
| Rate for Payer: PHCS PPO |
$95.70
|
| Rate for Payer: Three Rivers PPO |
$73.24
|
| Rate for Payer: TriWest Veterans Administration |
$56.64
|
| Rate for Payer: United Healthcare Commercial |
$84.96
|
| Rate for Payer: United Healthcare Medicare |
$56.64
|
| Rate for Payer: WINHealth Partners Commercial |
$95.70
|
| Rate for Payer: Wise Provider Network Commercial |
$92.77
|
|
|
SUT VLOC 90 3-0 VL 6" CV-23
|
Facility
|
OP
|
$97.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.81 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.70
|
| Rate for Payer: Aetna of WY Medicare |
$64.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.74
|
| Rate for Payer: Altius Commercial |
$93.74
|
| Rate for Payer: Beech Street Commercial |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.17
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.72
|
| Rate for Payer: Cigna of WY Commercial |
$95.70
|
| Rate for Payer: Entrust Commercial |
$92.77
|
| Rate for Payer: First Choice Health Commercial |
$92.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.64
|
| Rate for Payer: HealthUtah PPO |
$97.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.72
|
| Rate for Payer: Multiplan Medicare/VA |
$53.81
|
| Rate for Payer: One Health Plan of WY PPO |
$95.70
|
| Rate for Payer: PacificSource Commercial |
$87.88
|
| Rate for Payer: PHCS PPO |
$95.70
|
| Rate for Payer: Three Rivers PPO |
$73.24
|
| Rate for Payer: TriWest Veterans Administration |
$56.64
|
| Rate for Payer: United Healthcare Commercial |
$84.96
|
| Rate for Payer: United Healthcare Medicare |
$56.64
|
| Rate for Payer: WINHealth Partners Commercial |
$95.70
|
| Rate for Payer: Wise Provider Network Commercial |
$92.77
|
|
|
SUT VLOC 90 3-0 VL 6" CV-23
|
Facility
|
IP
|
$97.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.23 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.74
|
| Rate for Payer: Altius Commercial |
$93.74
|
| Rate for Payer: Beech Street Commercial |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.17
|
| Rate for Payer: Cash Price |
$68.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.72
|
| Rate for Payer: Cigna of WY Commercial |
$95.70
|
| Rate for Payer: Entrust Commercial |
$92.77
|
| Rate for Payer: First Choice Health Commercial |
$92.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.45
|
| Rate for Payer: HealthUtah PPO |
$97.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.72
|
| Rate for Payer: Multiplan Medicare/VA |
$61.23
|
| Rate for Payer: One Health Plan of WY PPO |
$95.70
|
| Rate for Payer: PacificSource Commercial |
$87.88
|
| Rate for Payer: PHCS PPO |
$95.70
|
| Rate for Payer: Three Rivers PPO |
$73.24
|
| Rate for Payer: TriWest Veterans Administration |
$64.45
|
| Rate for Payer: United Healthcare Commercial |
$84.96
|
| Rate for Payer: United Healthcare Medicare |
$64.45
|
| Rate for Payer: WINHealth Partners Commercial |
$92.77
|
| Rate for Payer: Wise Provider Network Commercial |
$92.77
|
|
|
SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 99058
|
| Hospital Charge Code |
99058
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.84
|
| Rate for Payer: Beech Street Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.76
|
| Rate for Payer: Cigna of WY Commercial |
$105.84
|
| Rate for Payer: First Choice Health Commercial |
$97.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.60
|
| Rate for Payer: HealthUtah PPO |
$108.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.76
|
| Rate for Payer: One Health Plan of WY PPO |
$105.84
|
| Rate for Payer: PacificSource Commercial |
$97.20
|
| Rate for Payer: PHCS PPO |
$102.60
|
| Rate for Payer: Three Rivers PPO |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$93.96
|
| Rate for Payer: WINHealth Partners Commercial |
$102.60
|
|
|
SWIVELOCK 3.5X13.5MM ANCHOR
|
Facility
|
OP
|
$1,737.40
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.31 |
| Max. Negotiated Rate |
$1,737.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,702.65
|
| Rate for Payer: Aetna of WY Medicare |
$1,146.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,667.90
|
| Rate for Payer: Altius Commercial |
$1,667.90
|
| Rate for Payer: Beech Street Commercial |
$1,702.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,426.41
|
| Rate for Payer: Cash Price |
$1,216.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,685.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,702.65
|
| Rate for Payer: Entrust Commercial |
$1,650.53
|
| Rate for Payer: First Choice Health Commercial |
$1,650.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,650.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,007.69
|
| Rate for Payer: HealthUtah PPO |
$1,737.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,685.28
|
| Rate for Payer: Multiplan Medicare/VA |
$957.31
|
| Rate for Payer: One Health Plan of WY PPO |
$1,702.65
|
| Rate for Payer: PacificSource Commercial |
$1,563.66
|
| Rate for Payer: PHCS PPO |
$1,702.65
|
| Rate for Payer: Three Rivers PPO |
$1,303.05
|
| Rate for Payer: TriWest Veterans Administration |
$1,007.69
|
| Rate for Payer: United Healthcare Commercial |
$1,511.54
|
| Rate for Payer: United Healthcare Medicare |
$1,007.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,702.65
|
| Rate for Payer: Wise Provider Network Commercial |
$1,650.53
|
|
|
SWIVELOCK 3.5X13.5MM ANCHOR
|
Facility
|
IP
|
$1,737.40
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.35 |
| Max. Negotiated Rate |
$1,737.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,702.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,667.90
|
| Rate for Payer: Altius Commercial |
$1,667.90
|
| Rate for Payer: Beech Street Commercial |
$1,702.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,426.41
|
| Rate for Payer: Cash Price |
$1,216.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,685.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,702.65
|
| Rate for Payer: Entrust Commercial |
$1,650.53
|
| Rate for Payer: First Choice Health Commercial |
$1,650.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,650.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,146.68
|
| Rate for Payer: HealthUtah PPO |
$1,737.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,685.28
|
| Rate for Payer: Multiplan Medicare/VA |
$1,089.35
|
| Rate for Payer: One Health Plan of WY PPO |
$1,702.65
|
| Rate for Payer: PacificSource Commercial |
$1,563.66
|
| Rate for Payer: PHCS PPO |
$1,702.65
|
| Rate for Payer: Three Rivers PPO |
$1,303.05
|
| Rate for Payer: TriWest Veterans Administration |
$1,146.68
|
| Rate for Payer: United Healthcare Commercial |
$1,511.54
|
| Rate for Payer: United Healthcare Medicare |
$1,146.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,650.53
|
| Rate for Payer: Wise Provider Network Commercial |
$1,650.53
|
|
