|
SWIVELOCK 3.5X13.5MM KIT
|
Facility
|
IP
|
$1,124.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.87 |
| Max. Negotiated Rate |
$1,124.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,079.23
|
| Rate for Payer: Altius Commercial |
$1,079.23
|
| Rate for Payer: Beech Street Commercial |
$1,101.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$922.97
|
| Rate for Payer: Cash Price |
$786.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.72
|
| Rate for Payer: Entrust Commercial |
$1,067.99
|
| Rate for Payer: First Choice Health Commercial |
$1,067.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$741.97
|
| Rate for Payer: HealthUtah PPO |
$1,124.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.47
|
| Rate for Payer: Multiplan Medicare/VA |
$704.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.72
|
| Rate for Payer: PacificSource Commercial |
$1,011.78
|
| Rate for Payer: PHCS PPO |
$1,101.72
|
| Rate for Payer: Three Rivers PPO |
$843.15
|
| Rate for Payer: TriWest Veterans Administration |
$741.97
|
| Rate for Payer: United Healthcare Commercial |
$978.05
|
| Rate for Payer: United Healthcare Medicare |
$741.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,067.99
|
| Rate for Payer: Wise Provider Network Commercial |
$1,067.99
|
|
|
SWIVELOCK 3.5X13.5MM KIT
|
Facility
|
OP
|
$1,124.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.43 |
| Max. Negotiated Rate |
$1,124.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.72
|
| Rate for Payer: Aetna of WY Medicare |
$741.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,079.23
|
| Rate for Payer: Altius Commercial |
$1,079.23
|
| Rate for Payer: Beech Street Commercial |
$1,101.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$922.97
|
| Rate for Payer: Cash Price |
$786.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.72
|
| Rate for Payer: Entrust Commercial |
$1,067.99
|
| Rate for Payer: First Choice Health Commercial |
$1,067.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$652.04
|
| Rate for Payer: HealthUtah PPO |
$1,124.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.47
|
| Rate for Payer: Multiplan Medicare/VA |
$619.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.72
|
| Rate for Payer: PacificSource Commercial |
$1,011.78
|
| Rate for Payer: PHCS PPO |
$1,101.72
|
| Rate for Payer: Three Rivers PPO |
$843.15
|
| Rate for Payer: TriWest Veterans Administration |
$652.04
|
| Rate for Payer: United Healthcare Commercial |
$978.05
|
| Rate for Payer: United Healthcare Medicare |
$652.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,101.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1,067.99
|
|
|
SWIVELOCK 3.5X8.5MM 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
|
|
|
SWIVELOCK 3.5X8.5MM 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 3.5X8.5MM KIT
|
Facility
|
OP
|
$1,124.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.43 |
| Max. Negotiated Rate |
$1,124.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.72
|
| Rate for Payer: Aetna of WY Medicare |
$741.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,079.23
|
| Rate for Payer: Altius Commercial |
$1,079.23
|
| Rate for Payer: Beech Street Commercial |
$1,101.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$922.97
|
| Rate for Payer: Cash Price |
$786.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.72
|
| Rate for Payer: Entrust Commercial |
$1,067.99
|
| Rate for Payer: First Choice Health Commercial |
$1,067.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$652.04
|
| Rate for Payer: HealthUtah PPO |
$1,124.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.47
|
| Rate for Payer: Multiplan Medicare/VA |
$619.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.72
|
| Rate for Payer: PacificSource Commercial |
$1,011.78
|
| Rate for Payer: PHCS PPO |
$1,101.72
|
| Rate for Payer: Three Rivers PPO |
$843.15
|
| Rate for Payer: TriWest Veterans Administration |
$652.04
|
| Rate for Payer: United Healthcare Commercial |
$978.05
|
| Rate for Payer: United Healthcare Medicare |
$652.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,101.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1,067.99
|
|
|
SWIVELOCK 3.5X8.5MM KIT
|
Facility
|
IP
|
$1,124.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.87 |
| Max. Negotiated Rate |
$1,124.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,101.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,079.23
|
| Rate for Payer: Altius Commercial |
$1,079.23
|
| Rate for Payer: Beech Street Commercial |
$1,101.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$922.97
|
| Rate for Payer: Cash Price |
$786.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,090.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,101.72
|
| Rate for Payer: Entrust Commercial |
$1,067.99
|
| Rate for Payer: First Choice Health Commercial |
$1,067.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,067.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$741.97
|
| Rate for Payer: HealthUtah PPO |
$1,124.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,090.47
|
| Rate for Payer: Multiplan Medicare/VA |
$704.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,101.72
|
| Rate for Payer: PacificSource Commercial |
$1,011.78
|
| Rate for Payer: PHCS PPO |
$1,101.72
|
| Rate for Payer: Three Rivers PPO |
$843.15
|
| Rate for Payer: TriWest Veterans Administration |
$741.97
|
| Rate for Payer: United Healthcare Commercial |
$978.05
|
| Rate for Payer: United Healthcare Medicare |
$741.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,067.99
|
| Rate for Payer: Wise Provider Network Commercial |
$1,067.99
|
|
|
SWIVELOCK 4.75X19.1MM 2324PSLC
|
Facility
|
IP
|
$1,533.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.19 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,502.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,471.68
|
| Rate for Payer: Altius Commercial |
$1,471.68
|
| Rate for Payer: Beech Street Commercial |
$1,502.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,258.59
|
| Rate for Payer: Cash Price |
$1,073.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,487.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,502.34
|
| Rate for Payer: Entrust Commercial |
$1,456.35
|
| Rate for Payer: First Choice Health Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,011.78
|
| Rate for Payer: HealthUtah PPO |
$1,533.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,487.01
|
| Rate for Payer: Multiplan Medicare/VA |
$961.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,502.34
|
| Rate for Payer: PacificSource Commercial |
$1,379.70
|
| Rate for Payer: PHCS PPO |
$1,502.34
|
| Rate for Payer: Three Rivers PPO |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,011.78
|
| Rate for Payer: United Healthcare Commercial |
$1,333.71
|
| Rate for Payer: United Healthcare Medicare |
$1,011.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1,456.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,456.35
|
|
|
SWIVELOCK 4.75X19.1MM 2324PSLC
|
Facility
|
OP
|
$1,533.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$844.68 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,502.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,011.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,471.68
|
| Rate for Payer: Altius Commercial |
$1,471.68
|
| Rate for Payer: Beech Street Commercial |
$1,502.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,258.59
|
| Rate for Payer: Cash Price |
$1,073.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,487.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,502.34
|
| Rate for Payer: Entrust Commercial |
$1,456.35
|
| Rate for Payer: First Choice Health Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,456.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$889.14
|
| Rate for Payer: HealthUtah PPO |
$1,533.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,487.01
|
| Rate for Payer: Multiplan Medicare/VA |
$844.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,502.34
|
| Rate for Payer: PacificSource Commercial |
$1,379.70
|
| Rate for Payer: PHCS PPO |
$1,502.34
|
| Rate for Payer: Three Rivers PPO |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration |
$889.14
|
| Rate for Payer: United Healthcare Commercial |
$1,333.71
|
| Rate for Payer: United Healthcare Medicare |
$889.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1,502.34
|
| Rate for Payer: Wise Provider Network Commercial |
$1,456.35
|
|
|
SWIVELOCK 4.75X24.5MM 2324PSLM
|
Facility
|
OP
|
$1,635.20
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$1,635.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,602.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,079.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,569.79
|
| Rate for Payer: Altius Commercial |
$1,569.79
|
| Rate for Payer: Beech Street Commercial |
$1,602.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,342.50
|
| Rate for Payer: Cash Price |
$1,144.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,586.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,602.50
|
| Rate for Payer: Entrust Commercial |
$1,553.44
|
| Rate for Payer: First Choice Health Commercial |
$1,553.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,553.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$948.42
|
| Rate for Payer: HealthUtah PPO |
$1,635.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,586.14
|
| Rate for Payer: Multiplan Medicare/VA |
$901.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,602.50
|
| Rate for Payer: PacificSource Commercial |
$1,471.68
|
| Rate for Payer: PHCS PPO |
$1,602.50
|
| Rate for Payer: Three Rivers PPO |
$1,226.40
|
| Rate for Payer: TriWest Veterans Administration |
$948.42
|
| Rate for Payer: United Healthcare Commercial |
$1,422.62
|
| Rate for Payer: United Healthcare Medicare |
$948.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,602.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,553.44
|
|
|
SWIVELOCK 4.75X24.5MM 2324PSLM
|
Facility
|
IP
|
$1,635.20
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.27 |
| Max. Negotiated Rate |
$1,635.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,602.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,569.79
|
| Rate for Payer: Altius Commercial |
$1,569.79
|
| Rate for Payer: Beech Street Commercial |
$1,602.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,342.50
|
| Rate for Payer: Cash Price |
$1,144.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,586.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,602.50
|
| Rate for Payer: Entrust Commercial |
$1,553.44
|
| Rate for Payer: First Choice Health Commercial |
$1,553.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,553.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,079.23
|
| Rate for Payer: HealthUtah PPO |
$1,635.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,586.14
|
| Rate for Payer: Multiplan Medicare/VA |
$1,025.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,602.50
|
| Rate for Payer: PacificSource Commercial |
$1,471.68
|
| Rate for Payer: PHCS PPO |
$1,602.50
|
| Rate for Payer: Three Rivers PPO |
$1,226.40
|
| Rate for Payer: TriWest Veterans Administration |
$1,079.23
|
| Rate for Payer: United Healthcare Commercial |
$1,422.62
|
| Rate for Payer: United Healthcare Medicare |
$1,079.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,553.44
|
| Rate for Payer: Wise Provider Network Commercial |
$1,553.44
|
|
|
SWIVELOCK 5.5X19.1MM 2323PSLC
|
Facility
|
OP
|
$962.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.34 |
| Max. Negotiated Rate |
$962.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$943.25
|
| Rate for Payer: Aetna of WY Medicare |
$635.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$924.00
|
| Rate for Payer: Altius Commercial |
$924.00
|
| Rate for Payer: Beech Street Commercial |
$943.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$790.21
|
| Rate for Payer: Cash Price |
$673.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$933.62
|
| Rate for Payer: Cigna of WY Commercial |
$943.25
|
| Rate for Payer: Entrust Commercial |
$914.38
|
| Rate for Payer: First Choice Health Commercial |
$914.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$914.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$558.25
|
| Rate for Payer: HealthUtah PPO |
$962.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$933.62
|
| Rate for Payer: Multiplan Medicare/VA |
$530.34
|
| Rate for Payer: One Health Plan of WY PPO |
$943.25
|
| Rate for Payer: PacificSource Commercial |
$866.25
|
| Rate for Payer: PHCS PPO |
$943.25
|
| Rate for Payer: Three Rivers PPO |
$721.88
|
| Rate for Payer: TriWest Veterans Administration |
$558.25
|
| Rate for Payer: United Healthcare Commercial |
$837.38
|
| Rate for Payer: United Healthcare Medicare |
$558.25
|
| Rate for Payer: WINHealth Partners Commercial |
$943.25
|
| Rate for Payer: Wise Provider Network Commercial |
$914.38
|
|
|
SWIVELOCK 5.5X19.1MM 2323PSLC
|
Facility
|
IP
|
$962.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.49 |
| Max. Negotiated Rate |
$962.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$943.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$924.00
|
| Rate for Payer: Altius Commercial |
$924.00
|
| Rate for Payer: Beech Street Commercial |
$943.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$790.21
|
| Rate for Payer: Cash Price |
$673.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$933.62
|
| Rate for Payer: Cigna of WY Commercial |
$943.25
|
| Rate for Payer: Entrust Commercial |
$914.38
|
| Rate for Payer: First Choice Health Commercial |
$914.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$914.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$635.25
|
| Rate for Payer: HealthUtah PPO |
$962.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$933.62
|
| Rate for Payer: Multiplan Medicare/VA |
$603.49
|
| Rate for Payer: One Health Plan of WY PPO |
$943.25
|
| Rate for Payer: PacificSource Commercial |
$866.25
|
| Rate for Payer: PHCS PPO |
$943.25
|
| Rate for Payer: Three Rivers PPO |
$721.88
|
| Rate for Payer: TriWest Veterans Administration |
$635.25
|
| Rate for Payer: United Healthcare Commercial |
$837.38
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
| Rate for Payer: WINHealth Partners Commercial |
$914.38
|
| Rate for Payer: Wise Provider Network Commercial |
$914.38
|
|
|
SYMPATHECTOMY ULNAR ARTERY
|
Professional
|
Both
|
$3,586.00
|
|
|
Service Code
|
HCPCS 64822
|
| Hospital Charge Code |
64822
|
| Min. Negotiated Rate |
$577.22 |
| Max. Negotiated Rate |
$3,586.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,514.28
|
| Rate for Payer: Aetna of WY Medicare |
$679.08
|
| Rate for Payer: Beech Street Commercial |
$3,406.70
|
| Rate for Payer: Cash Price |
$2,510.20
|
| Rate for Payer: Cash Price |
$2,510.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,478.42
|
| Rate for Payer: Cigna of WY Commercial |
$3,514.28
|
| Rate for Payer: First Choice Health Commercial |
$3,227.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,406.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$679.08
|
| Rate for Payer: HealthUtah PPO |
$3,586.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,478.42
|
| Rate for Payer: Multiplan Medicare/VA |
$577.22
|
| Rate for Payer: One Health Plan of WY PPO |
$3,514.28
|
| Rate for Payer: PacificSource Commercial |
$3,227.40
|
| Rate for Payer: PHCS PPO |
$3,406.70
|
| Rate for Payer: Three Rivers PPO |
$2,689.50
|
| Rate for Payer: TriWest Veterans Administration |
$679.08
|
| Rate for Payer: United Healthcare Commercial |
$3,119.82
|
| Rate for Payer: United Healthcare Medicare |
$679.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,048.10
|
|
|
SYNERGY XD 2.25 X 12MM
|
Facility
|
OP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.16 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,471.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,398.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,471.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,471.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,486.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 12MM
|
Facility
|
IP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.01 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,591.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,674.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,410.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 16MM
|
Facility
|
IP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.01 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,591.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,674.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,410.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 16MM
|
Facility
|
OP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.16 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,471.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,398.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,471.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,471.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,486.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 20MM
|
Facility
|
IP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.01 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,591.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,674.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,410.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 20MM
|
Facility
|
OP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.16 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,471.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,398.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,471.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,471.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,486.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 24MM
|
Facility
|
IP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.01 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,591.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,674.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,410.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 24MM
|
Facility
|
OP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.16 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,471.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,398.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,471.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,471.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,486.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 28MM
|
Facility
|
IP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.01 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,591.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,674.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,410.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 28MM
|
Facility
|
OP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.16 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,471.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,398.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,471.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,471.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,486.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 32MM
|
Facility
|
IP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.01 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,591.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,674.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,410.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
|
SYNERGY XD 2.25 X 32MM
|
Facility
|
OP
|
$2,537.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.16 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,436.00
|
| Rate for Payer: Altius Commercial |
$2,436.00
|
| Rate for Payer: Beech Street Commercial |
$2,486.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,083.29
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.75
|
| Rate for Payer: Entrust Commercial |
$2,410.62
|
| Rate for Payer: First Choice Health Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,471.75
|
| Rate for Payer: HealthUtah PPO |
$2,537.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,398.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.75
|
| Rate for Payer: PacificSource Commercial |
$2,283.75
|
| Rate for Payer: PHCS PPO |
$2,486.75
|
| Rate for Payer: Three Rivers PPO |
$1,903.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,471.75
|
| Rate for Payer: United Healthcare Commercial |
$2,207.62
|
| Rate for Payer: United Healthcare Medicare |
$1,471.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2,486.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,410.62
|
|
