|
SYNERGY XD 4.50 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 4.50 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 4.50 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 4.50 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 4.50 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 4.50 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 5.00 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 5.00 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 5.00 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 5.00 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 5.00 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 5.00 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 5.00 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 5.00 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 5.00 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
|
|
|
SYNERGY XD 5.00 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 5.00 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 5.00 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
|
|
|
SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT
|
Professional
|
Both
|
$3,287.00
|
|
|
Service Code
|
HCPCS 25118
|
| Hospital Charge Code |
25118
|
| Min. Negotiated Rate |
$322.25 |
| Max. Negotiated Rate |
$3,287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,221.26
|
| Rate for Payer: Aetna of WY Medicare |
$379.12
|
| Rate for Payer: Beech Street Commercial |
$3,122.65
|
| Rate for Payer: Cash Price |
$2,300.90
|
| Rate for Payer: Cash Price |
$2,300.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,188.39
|
| Rate for Payer: Cigna of WY Commercial |
$3,221.26
|
| Rate for Payer: First Choice Health Commercial |
$2,958.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,122.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.12
|
| Rate for Payer: HealthUtah PPO |
$3,287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,188.39
|
| Rate for Payer: Multiplan Medicare/VA |
$322.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,221.26
|
| Rate for Payer: PacificSource Commercial |
$2,958.30
|
| Rate for Payer: PHCS PPO |
$3,122.65
|
| Rate for Payer: Three Rivers PPO |
$2,465.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.12
|
| Rate for Payer: United Healthcare Commercial |
$2,859.69
|
| Rate for Payer: United Healthcare Medicare |
$379.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,793.95
|
|
|
SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN
|
Professional
|
Both
|
$3,785.00
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
26145
|
| Min. Negotiated Rate |
$431.38 |
| Max. Negotiated Rate |
$3,785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,709.30
|
| Rate for Payer: Aetna of WY Medicare |
$507.50
|
| Rate for Payer: Beech Street Commercial |
$3,595.75
|
| Rate for Payer: Cash Price |
$2,649.50
|
| Rate for Payer: Cash Price |
$2,649.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,671.45
|
| Rate for Payer: Cigna of WY Commercial |
$3,709.30
|
| Rate for Payer: First Choice Health Commercial |
$3,406.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,595.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.50
|
| Rate for Payer: HealthUtah PPO |
$3,785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,671.45
|
| Rate for Payer: Multiplan Medicare/VA |
$431.38
|
| Rate for Payer: One Health Plan of WY PPO |
$3,709.30
|
| Rate for Payer: PacificSource Commercial |
$3,406.50
|
| Rate for Payer: PHCS PPO |
$3,595.75
|
| Rate for Payer: Three Rivers PPO |
$2,838.75
|
| Rate for Payer: TriWest Veterans Administration |
$507.50
|
| Rate for Payer: United Healthcare Commercial |
$3,292.95
|
| Rate for Payer: United Healthcare Medicare |
$507.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,217.25
|
|
|
SYNVISC OR SYNVISC-ONE
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
J7325
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$59.78
|
| Rate for Payer: Aetna of WY Medicare |
$8.88
|
| Rate for Payer: Beech Street Commercial |
$57.95
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.17
|
| Rate for Payer: Cigna of WY Commercial |
$59.78
|
| Rate for Payer: First Choice Health Commercial |
$54.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.88
|
| Rate for Payer: HealthUtah PPO |
$61.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.17
|
| Rate for Payer: Multiplan Medicare/VA |
$7.54
|
| Rate for Payer: One Health Plan of WY PPO |
$59.78
|
| Rate for Payer: PacificSource Commercial |
$54.90
|
| Rate for Payer: PHCS PPO |
$57.95
|
| Rate for Payer: Three Rivers PPO |
$45.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.88
|
| Rate for Payer: United Healthcare Commercial |
$53.07
|
| Rate for Payer: United Healthcare Medicare |
$8.88
|
| Rate for Payer: WINHealth Partners Commercial |
$57.95
|
|
|
SYRINGE BARD IRRIG 0035280
|
Facility
|
IP
|
$1.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.60
|
| Rate for Payer: Altius Commercial |
$1.60
|
| Rate for Payer: Beech Street Commercial |
$1.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.62
|
| Rate for Payer: Cigna of WY Commercial |
$1.64
|
| Rate for Payer: Entrust Commercial |
$1.59
|
| Rate for Payer: First Choice Health Commercial |
$1.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.10
|
| Rate for Payer: HealthUtah PPO |
$1.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1.64
|
| Rate for Payer: PacificSource Commercial |
$1.50
|
| Rate for Payer: PHCS PPO |
$1.64
|
| Rate for Payer: Three Rivers PPO |
$1.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
| Rate for Payer: United Healthcare Medicare |
$1.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1.59
|
| Rate for Payer: Wise Provider Network Commercial |
$1.59
|
|
|
SYRINGE BARD IRRIG 0035280
|
Facility
|
OP
|
$1.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.64
|
| Rate for Payer: Aetna of WY Medicare |
$1.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.60
|
| Rate for Payer: Altius Commercial |
$1.60
|
| Rate for Payer: Beech Street Commercial |
$1.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.62
|
| Rate for Payer: Cigna of WY Commercial |
$1.64
|
| Rate for Payer: Entrust Commercial |
$1.59
|
| Rate for Payer: First Choice Health Commercial |
$1.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.97
|
| Rate for Payer: HealthUtah PPO |
$1.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.62
|
| Rate for Payer: Multiplan Medicare/VA |
$0.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1.64
|
| Rate for Payer: PacificSource Commercial |
$1.50
|
| Rate for Payer: PHCS PPO |
$1.64
|
| Rate for Payer: Three Rivers PPO |
$1.25
|
| Rate for Payer: TriWest Veterans Administration |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.45
|
| Rate for Payer: United Healthcare Medicare |
$0.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1.64
|
| Rate for Payer: Wise Provider Network Commercial |
$1.59
|
|
|
SYRINGE J-TIP INJ 8164-2001-25
|
Facility
|
OP
|
$17.05
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$17.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.71
|
| Rate for Payer: Aetna of WY Medicare |
$11.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.37
|
| Rate for Payer: Altius Commercial |
$16.37
|
| Rate for Payer: Beech Street Commercial |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.54
|
| Rate for Payer: Cigna of WY Commercial |
$16.71
|
| Rate for Payer: Entrust Commercial |
$16.20
|
| Rate for Payer: First Choice Health Commercial |
$16.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.89
|
| Rate for Payer: HealthUtah PPO |
$17.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.54
|
| Rate for Payer: Multiplan Medicare/VA |
$9.39
|
| Rate for Payer: One Health Plan of WY PPO |
$16.71
|
| Rate for Payer: PacificSource Commercial |
$15.34
|
| Rate for Payer: PHCS PPO |
$16.71
|
| Rate for Payer: Three Rivers PPO |
$12.79
|
| Rate for Payer: TriWest Veterans Administration |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$14.83
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
| Rate for Payer: WINHealth Partners Commercial |
$16.71
|
| Rate for Payer: Wise Provider Network Commercial |
$16.20
|
|
|
SYRINGE J-TIP INJ 8164-2001-25
|
Facility
|
IP
|
$17.05
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$17.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.37
|
| Rate for Payer: Altius Commercial |
$16.37
|
| Rate for Payer: Beech Street Commercial |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.54
|
| Rate for Payer: Cigna of WY Commercial |
$16.71
|
| Rate for Payer: Entrust Commercial |
$16.20
|
| Rate for Payer: First Choice Health Commercial |
$16.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.25
|
| Rate for Payer: HealthUtah PPO |
$17.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.54
|
| Rate for Payer: Multiplan Medicare/VA |
$10.69
|
| Rate for Payer: One Health Plan of WY PPO |
$16.71
|
| Rate for Payer: PacificSource Commercial |
$15.34
|
| Rate for Payer: PHCS PPO |
$16.71
|
| Rate for Payer: Three Rivers PPO |
$12.79
|
| Rate for Payer: TriWest Veterans Administration |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$14.83
|
| Rate for Payer: United Healthcare Medicare |
$11.25
|
| Rate for Payer: WINHealth Partners Commercial |
$16.20
|
| Rate for Payer: Wise Provider Network Commercial |
$16.20
|
|
