4059818_1 — Sugimesh Xb C-15
Cite this view
HANK Price Transparency. (n.d.). SUGIMESH XB C-15 (CDM 4059818_1) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/4059818_1?code_type=CDM
“SUGIMESH XB C-15 (CDM 4059818_1) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/4059818_1?code_type=CDM. Accessed .
“SUGIMESH XB C-15 (CDM 4059818_1) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/4059818_1?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $2,630–$5,317 (25th–75th percentile) across 1 hospital · 14 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 4059818_1 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.
Hospital rates (per row)
Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.
| Hospital | Payer | Plan | Negotiated rate | Gross | Cash | Observed | Source |
|---|---|---|---|---|---|---|---|
| TETON VALLEY HOSPITAL Outpatient | UHC MEDICARE ADVANTAGE | UHC MEDICARE ADVANTAGE | $2,574.39 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | TRIWEST-ALL PLANS | TRIWEST-ALL PLANS | $2,630.36 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | AETNA MEDICARE | AETNA MEDICARE | $2,630.36 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | SELECT HEALTH MEDICARE ADVANTAGE | SELECT HEALTH MEDICARE ADVANTAGE | $2,630.36 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | REGENCE BLUE SHIELD MEDICARE ADVANTAGE | REGENCE BLUE SHIELD MEDICARE ADVANTAGE | $2,630.36 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | PRIME HEALTH SERVICES-ALL OTHER PLANS | PRIME HEALTH SERVICES-ALL OTHER PLANS | $2,630.36 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | PRIME HEALTH MEDICARE ADVANTAGE | PRIME HEALTH MEDICARE ADVANTAGE | $2,630.36 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | HUMANA-ALL PLANS | HUMANA-ALL PLANS | $2,630.36 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | BLUE CROSS MCR ADV | BLUE CROSS MCR ADV | $2,656.66 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | FIRST CHOICE-ALL PLANS | FIRST CHOICE-ALL PLANS | $5,036.85 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | MODA-ALL PLANS | MODA-ALL PLANS | $5,036.85 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | BLUE CROSS QHP | BLUE CROSS QHP | $5,157.17 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | AETNA-ALL OTHER PLANS | AETNA-ALL OTHER PLANS | $5,204.75 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | CIGNA OAP | CIGNA OAP | $5,316.68 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | ST LUKES BRIGHTPATH-ALL PLANS | ST LUKES BRIGHTPATH-ALL PLANS | $5,316.68 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | UHC ALL PAYER-ALL OTHER PLANS | UHC ALL PAYER-ALL OTHER PLANS | $5,316.68 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | CIGNA PPO-ALL OTHER PLANS | CIGNA PPO-ALL OTHER PLANS | $5,316.68 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | SELECT HEALTH-ALL OTHER PLANS | SELECT HEALTH-ALL OTHER PLANS | $5,316.68 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | BLUE CROSS TRAD/PPO/POS-ALL OTHER PLANS | BLUE CROSS TRAD/PPO/POS-ALL OTHER PLANS | $5,428.61 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |
| TETON VALLEY HOSPITAL Outpatient | REGENCE BLUE SHIELD-ALL OTHER PLANS | REGENCE BLUE SHIELD-ALL OTHER PLANS | $5,484.57 | $5,596.50 | $4,477.20 | 2026-04-16 | MRF ↗ |