|
SYNERGY XD 2.75 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 2.75 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 2.75 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 2.75 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 2.75 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 2.75 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 2.75 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 2.75 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
|
|
|
SYNERGY XD 2.75 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 2.75 X 38MM
|
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 2.75 X 38MM
|
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 2.75 X 48MM
|
Facility
|
OP
|
$4,165.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.92 |
| Max. Negotiated Rate |
$4,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,081.70
|
| Rate for Payer: Aetna of WY Medicare |
$2,748.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,998.40
|
| Rate for Payer: Altius Commercial |
$3,998.40
|
| Rate for Payer: Beech Street Commercial |
$4,081.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,419.46
|
| Rate for Payer: Cash Price |
$2,915.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,040.05
|
| Rate for Payer: Cigna of WY Commercial |
$4,081.70
|
| Rate for Payer: Entrust Commercial |
$3,956.75
|
| Rate for Payer: First Choice Health Commercial |
$3,956.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,956.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,415.70
|
| Rate for Payer: HealthUtah PPO |
$4,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,040.05
|
| Rate for Payer: Multiplan Medicare/VA |
$2,294.92
|
| Rate for Payer: One Health Plan of WY PPO |
$4,081.70
|
| Rate for Payer: PacificSource Commercial |
$3,748.50
|
| Rate for Payer: PHCS PPO |
$4,081.70
|
| Rate for Payer: Three Rivers PPO |
$3,123.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,415.70
|
| Rate for Payer: United Healthcare Commercial |
$3,623.55
|
| Rate for Payer: United Healthcare Medicare |
$2,415.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,081.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3,956.75
|
|
|
SYNERGY XD 2.75 X 48MM
|
Facility
|
IP
|
$4,165.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,611.46 |
| Max. Negotiated Rate |
$4,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,081.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,998.40
|
| Rate for Payer: Altius Commercial |
$3,998.40
|
| Rate for Payer: Beech Street Commercial |
$4,081.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,419.46
|
| Rate for Payer: Cash Price |
$2,915.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,040.05
|
| Rate for Payer: Cigna of WY Commercial |
$4,081.70
|
| Rate for Payer: Entrust Commercial |
$3,956.75
|
| Rate for Payer: First Choice Health Commercial |
$3,956.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,956.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,748.90
|
| Rate for Payer: HealthUtah PPO |
$4,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,040.05
|
| Rate for Payer: Multiplan Medicare/VA |
$2,611.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,081.70
|
| Rate for Payer: PacificSource Commercial |
$3,748.50
|
| Rate for Payer: PHCS PPO |
$4,081.70
|
| Rate for Payer: Three Rivers PPO |
$3,123.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,748.90
|
| Rate for Payer: United Healthcare Commercial |
$3,623.55
|
| Rate for Payer: United Healthcare Medicare |
$2,748.90
|
| Rate for Payer: WINHealth Partners Commercial |
$3,956.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,956.75
|
|
|
SYNERGY XD 2.75 X 8MM
|
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 2.75 X 8MM
|
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 3.00 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 3.00 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 3.00 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 3.00 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 3.00 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 3.00 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 3.00 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 3.00 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 3.00 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 3.00 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
|
|
