|
COCHLEAR BI300 IMPLANT 3MM
|
Facility
|
OP
|
$5,950.00
|
|
| Hospital Charge Code |
2700020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,221.92 |
| Max. Negotiated Rate |
$5,950.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,831.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,927.00
|
| Rate for Payer: Altius Commercial |
$5,712.00
|
| Rate for Payer: Beech Street Commercial |
$5,831.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,771.50
|
| Rate for Payer: Cash Price |
$4,165.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,771.50
|
| Rate for Payer: Cigna of WY Commercial |
$5,831.00
|
| Rate for Payer: Entrust Commercial |
$5,652.50
|
| Rate for Payer: First Choice Health Commercial |
$5,652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,391.50
|
| Rate for Payer: HealthUtah PPO |
$5,950.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,771.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,221.92
|
| Rate for Payer: One Health Plan of WY PPO |
$5,831.00
|
| Rate for Payer: PacificSource Commercial |
$5,355.00
|
| Rate for Payer: PHCS PPO |
$5,831.00
|
| Rate for Payer: Three Rivers PPO |
$4,462.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,391.50
|
| Rate for Payer: United Healthcare Commercial |
$5,682.25
|
| Rate for Payer: United Healthcare Medicare |
$3,391.50
|
| Rate for Payer: WINHealth Partners Commercial |
$5,831.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5,652.50
|
|
|
COCHLEAR BI300 IMPLANT 4MM
|
Facility
|
OP
|
$5,950.00
|
|
| Hospital Charge Code |
2700021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,221.92 |
| Max. Negotiated Rate |
$5,950.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,831.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,927.00
|
| Rate for Payer: Altius Commercial |
$5,712.00
|
| Rate for Payer: Beech Street Commercial |
$5,831.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,771.50
|
| Rate for Payer: Cash Price |
$4,165.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,771.50
|
| Rate for Payer: Cigna of WY Commercial |
$5,831.00
|
| Rate for Payer: Entrust Commercial |
$5,652.50
|
| Rate for Payer: First Choice Health Commercial |
$5,652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,391.50
|
| Rate for Payer: HealthUtah PPO |
$5,950.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,771.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,221.92
|
| Rate for Payer: One Health Plan of WY PPO |
$5,831.00
|
| Rate for Payer: PacificSource Commercial |
$5,355.00
|
| Rate for Payer: PHCS PPO |
$5,831.00
|
| Rate for Payer: Three Rivers PPO |
$4,462.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,391.50
|
| Rate for Payer: United Healthcare Commercial |
$5,682.25
|
| Rate for Payer: United Healthcare Medicare |
$3,391.50
|
| Rate for Payer: WINHealth Partners Commercial |
$5,831.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5,652.50
|
|
|
COCHLEAR BI300 IMPLANT 4MM
|
Facility
|
IP
|
$5,950.00
|
|
| Hospital Charge Code |
2700021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,448.02 |
| Max. Negotiated Rate |
$5,950.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,831.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,808.00
|
| Rate for Payer: Altius Commercial |
$5,712.00
|
| Rate for Payer: Beech Street Commercial |
$5,831.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,771.50
|
| Rate for Payer: Cash Price |
$4,165.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,771.50
|
| Rate for Payer: Cigna of WY Commercial |
$5,831.00
|
| Rate for Payer: Entrust Commercial |
$5,652.50
|
| Rate for Payer: First Choice Health Commercial |
$5,652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,629.50
|
| Rate for Payer: HealthUtah PPO |
$5,950.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,771.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,448.02
|
| Rate for Payer: One Health Plan of WY PPO |
$5,831.00
|
| Rate for Payer: PacificSource Commercial |
$5,355.00
|
| Rate for Payer: PHCS PPO |
$5,831.00
|
| Rate for Payer: Three Rivers PPO |
$4,462.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,629.50
|
| Rate for Payer: United Healthcare Commercial |
$5,682.25
|
| Rate for Payer: United Healthcare Medicare |
$3,629.50
|
| Rate for Payer: WINHealth Partners Commercial |
$5,652.50
|
| Rate for Payer: Wise Provider Network Commercial |
$5,652.50
|
|
|
COCHLEAR CONICAL GUIDE DRILL 3+4MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
2700022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.78 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$537.60
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$512.40
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$486.78
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$512.40
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$512.40
|
| Rate for Payer: WINHealth Partners Commercial |
$798.00
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
COCHLEAR CONICAL GUIDE DRILL 3+4MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
2700022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.86 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$554.40
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$478.80
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$454.86
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$478.80
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$478.80
|
| Rate for Payer: WINHealth Partners Commercial |
$823.20
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
COCHLEAR DRILL INDICATOR
|
Facility
|
OP
|
$234.50
|
|
| Hospital Charge Code |
2700026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.98 |
| Max. Negotiated Rate |
$234.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.81
|
| Rate for Payer: Aetna of WY Medicare |
$154.77
|
| Rate for Payer: Altius Commercial |
$225.12
|
| Rate for Payer: Beech Street Commercial |
$229.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.46
|
| Rate for Payer: Cash Price |
$164.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.46
|
| Rate for Payer: Cigna of WY Commercial |
$229.81
|
| Rate for Payer: Entrust Commercial |
$222.78
|
| Rate for Payer: First Choice Health Commercial |
$222.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.66
|
| Rate for Payer: HealthUtah PPO |
$234.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.46
|
| Rate for Payer: Multiplan Medicare/VA |
$126.98
|
| Rate for Payer: One Health Plan of WY PPO |
$229.81
|
| Rate for Payer: PacificSource Commercial |
$211.05
|
| Rate for Payer: PHCS PPO |
$229.81
|
| Rate for Payer: Three Rivers PPO |
$175.88
|
| Rate for Payer: TriWest Veterans Administration |
$133.66
|
| Rate for Payer: United Healthcare Commercial |
$223.95
|
| Rate for Payer: United Healthcare Medicare |
$133.66
|
| Rate for Payer: WINHealth Partners Commercial |
$229.81
|
| Rate for Payer: Wise Provider Network Commercial |
$222.78
|
|
|
COCHLEAR DRILL INDICATOR
|
Facility
|
IP
|
$234.50
|
|
| Hospital Charge Code |
2700026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.89 |
| Max. Negotiated Rate |
$234.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.81
|
| Rate for Payer: Aetna of WY Medicare |
$150.08
|
| Rate for Payer: Altius Commercial |
$225.12
|
| Rate for Payer: Beech Street Commercial |
$229.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.46
|
| Rate for Payer: Cash Price |
$164.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.46
|
| Rate for Payer: Cigna of WY Commercial |
$229.81
|
| Rate for Payer: Entrust Commercial |
$222.78
|
| Rate for Payer: First Choice Health Commercial |
$222.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.04
|
| Rate for Payer: HealthUtah PPO |
$234.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.46
|
| Rate for Payer: Multiplan Medicare/VA |
$135.89
|
| Rate for Payer: One Health Plan of WY PPO |
$229.81
|
| Rate for Payer: PacificSource Commercial |
$211.05
|
| Rate for Payer: PHCS PPO |
$229.81
|
| Rate for Payer: Three Rivers PPO |
$175.88
|
| Rate for Payer: TriWest Veterans Administration |
$143.04
|
| Rate for Payer: United Healthcare Commercial |
$223.95
|
| Rate for Payer: United Healthcare Medicare |
$143.04
|
| Rate for Payer: WINHealth Partners Commercial |
$222.78
|
| Rate for Payer: Wise Provider Network Commercial |
$222.78
|
|
|
COCHLEAR IMPLANT INSERTER
|
Facility
|
IP
|
$1,487.50
|
|
| Hospital Charge Code |
2700029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$862.01 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,457.75
|
| Rate for Payer: Aetna of WY Medicare |
$952.00
|
| Rate for Payer: Altius Commercial |
$1,428.00
|
| Rate for Payer: Beech Street Commercial |
$1,457.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,442.88
|
| Rate for Payer: Cash Price |
$1,041.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,442.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,457.75
|
| Rate for Payer: Entrust Commercial |
$1,413.12
|
| Rate for Payer: First Choice Health Commercial |
$1,413.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,413.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$907.38
|
| Rate for Payer: HealthUtah PPO |
$1,487.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,442.88
|
| Rate for Payer: Multiplan Medicare/VA |
$862.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,457.75
|
| Rate for Payer: PacificSource Commercial |
$1,338.75
|
| Rate for Payer: PHCS PPO |
$1,457.75
|
| Rate for Payer: Three Rivers PPO |
$1,115.62
|
| Rate for Payer: TriWest Veterans Administration |
$907.38
|
| Rate for Payer: United Healthcare Commercial |
$1,420.56
|
| Rate for Payer: United Healthcare Medicare |
$907.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,413.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,413.12
|
|
|
COCHLEAR IMPLANT INSERTER
|
Facility
|
OP
|
$1,487.50
|
|
| Hospital Charge Code |
2700029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$805.48 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,457.75
|
| Rate for Payer: Aetna of WY Medicare |
$981.75
|
| Rate for Payer: Altius Commercial |
$1,428.00
|
| Rate for Payer: Beech Street Commercial |
$1,457.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,442.88
|
| Rate for Payer: Cash Price |
$1,041.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,442.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,457.75
|
| Rate for Payer: Entrust Commercial |
$1,413.12
|
| Rate for Payer: First Choice Health Commercial |
$1,413.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,413.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$847.88
|
| Rate for Payer: HealthUtah PPO |
$1,487.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,442.88
|
| Rate for Payer: Multiplan Medicare/VA |
$805.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,457.75
|
| Rate for Payer: PacificSource Commercial |
$1,338.75
|
| Rate for Payer: PHCS PPO |
$1,457.75
|
| Rate for Payer: Three Rivers PPO |
$1,115.62
|
| Rate for Payer: TriWest Veterans Administration |
$847.88
|
| Rate for Payer: United Healthcare Commercial |
$1,420.56
|
| Rate for Payer: United Healthcare Medicare |
$847.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,457.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,413.12
|
|
|
COCHLEAR INSTRUMENT CASE
|
Facility
|
IP
|
$3,675.00
|
|
| Hospital Charge Code |
2700033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,129.66 |
| Max. Negotiated Rate |
$3,675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,601.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,352.00
|
| Rate for Payer: Altius Commercial |
$3,528.00
|
| Rate for Payer: Beech Street Commercial |
$3,601.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,564.75
|
| Rate for Payer: Cash Price |
$2,572.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,564.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,601.50
|
| Rate for Payer: Entrust Commercial |
$3,491.25
|
| Rate for Payer: First Choice Health Commercial |
$3,491.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,491.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,241.75
|
| Rate for Payer: HealthUtah PPO |
$3,675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,564.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,129.66
|
| Rate for Payer: One Health Plan of WY PPO |
$3,601.50
|
| Rate for Payer: PacificSource Commercial |
$3,307.50
|
| Rate for Payer: PHCS PPO |
$3,601.50
|
| Rate for Payer: Three Rivers PPO |
$2,756.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,241.75
|
| Rate for Payer: United Healthcare Commercial |
$3,509.62
|
| Rate for Payer: United Healthcare Medicare |
$2,241.75
|
| Rate for Payer: WINHealth Partners Commercial |
$3,491.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,491.25
|
|
|
COCHLEAR INSTRUMENT CASE
|
Facility
|
OP
|
$3,675.00
|
|
| Hospital Charge Code |
2700033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,990.01 |
| Max. Negotiated Rate |
$3,675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,601.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,425.50
|
| Rate for Payer: Altius Commercial |
$3,528.00
|
| Rate for Payer: Beech Street Commercial |
$3,601.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,564.75
|
| Rate for Payer: Cash Price |
$2,572.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,564.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,601.50
|
| Rate for Payer: Entrust Commercial |
$3,491.25
|
| Rate for Payer: First Choice Health Commercial |
$3,491.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,491.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,094.75
|
| Rate for Payer: HealthUtah PPO |
$3,675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,564.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,990.01
|
| Rate for Payer: One Health Plan of WY PPO |
$3,601.50
|
| Rate for Payer: PacificSource Commercial |
$3,307.50
|
| Rate for Payer: PHCS PPO |
$3,601.50
|
| Rate for Payer: Three Rivers PPO |
$2,756.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,094.75
|
| Rate for Payer: United Healthcare Commercial |
$3,509.62
|
| Rate for Payer: United Healthcare Medicare |
$2,094.75
|
| Rate for Payer: WINHealth Partners Commercial |
$3,601.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,491.25
|
|
|
COCHLEAR MACHINE SCREWDRIVER 25MM UNIGRIP
|
Facility
|
IP
|
$437.50
|
|
| Hospital Charge Code |
2700025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.53 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.75
|
| Rate for Payer: Aetna of WY Medicare |
$280.00
|
| Rate for Payer: Altius Commercial |
$420.00
|
| Rate for Payer: Beech Street Commercial |
$428.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$424.38
|
| Rate for Payer: Cash Price |
$306.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.38
|
| Rate for Payer: Cigna of WY Commercial |
$428.75
|
| Rate for Payer: Entrust Commercial |
$415.62
|
| Rate for Payer: First Choice Health Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.88
|
| Rate for Payer: HealthUtah PPO |
$437.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.38
|
| Rate for Payer: Multiplan Medicare/VA |
$253.53
|
| Rate for Payer: One Health Plan of WY PPO |
$428.75
|
| Rate for Payer: PacificSource Commercial |
$393.75
|
| Rate for Payer: PHCS PPO |
$428.75
|
| Rate for Payer: Three Rivers PPO |
$328.12
|
| Rate for Payer: TriWest Veterans Administration |
$266.88
|
| Rate for Payer: United Healthcare Commercial |
$417.81
|
| Rate for Payer: United Healthcare Medicare |
$266.88
|
| Rate for Payer: WINHealth Partners Commercial |
$415.62
|
| Rate for Payer: Wise Provider Network Commercial |
$415.62
|
|
|
COCHLEAR MACHINE SCREWDRIVER 25MM UNIGRIP
|
Facility
|
OP
|
$437.50
|
|
| Hospital Charge Code |
2700025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.91 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.75
|
| Rate for Payer: Aetna of WY Medicare |
$288.75
|
| Rate for Payer: Altius Commercial |
$420.00
|
| Rate for Payer: Beech Street Commercial |
$428.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$424.38
|
| Rate for Payer: Cash Price |
$306.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.38
|
| Rate for Payer: Cigna of WY Commercial |
$428.75
|
| Rate for Payer: Entrust Commercial |
$415.62
|
| Rate for Payer: First Choice Health Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.38
|
| Rate for Payer: HealthUtah PPO |
$437.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.38
|
| Rate for Payer: Multiplan Medicare/VA |
$236.91
|
| Rate for Payer: One Health Plan of WY PPO |
$428.75
|
| Rate for Payer: PacificSource Commercial |
$393.75
|
| Rate for Payer: PHCS PPO |
$428.75
|
| Rate for Payer: Three Rivers PPO |
$328.12
|
| Rate for Payer: TriWest Veterans Administration |
$249.38
|
| Rate for Payer: United Healthcare Commercial |
$417.81
|
| Rate for Payer: United Healthcare Medicare |
$249.38
|
| Rate for Payer: WINHealth Partners Commercial |
$428.75
|
| Rate for Payer: Wise Provider Network Commercial |
$415.62
|
|
|
COCHLEAR OSIA 2(I) SOUND PROCESSOR KIT
|
Facility
|
OP
|
$15,522.50
|
|
| Hospital Charge Code |
2700032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,405.43 |
| Max. Negotiated Rate |
$15,522.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15,212.05
|
| Rate for Payer: Aetna of WY Medicare |
$10,244.85
|
| Rate for Payer: Altius Commercial |
$14,901.60
|
| Rate for Payer: Beech Street Commercial |
$15,212.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,056.82
|
| Rate for Payer: Cash Price |
$10,865.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,056.82
|
| Rate for Payer: Cigna of WY Commercial |
$15,212.05
|
| Rate for Payer: Entrust Commercial |
$14,746.38
|
| Rate for Payer: First Choice Health Commercial |
$14,746.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,746.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,847.82
|
| Rate for Payer: HealthUtah PPO |
$15,522.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,056.82
|
| Rate for Payer: Multiplan Medicare/VA |
$8,405.43
|
| Rate for Payer: One Health Plan of WY PPO |
$15,212.05
|
| Rate for Payer: PacificSource Commercial |
$13,970.25
|
| Rate for Payer: PHCS PPO |
$15,212.05
|
| Rate for Payer: Three Rivers PPO |
$11,641.88
|
| Rate for Payer: TriWest Veterans Administration |
$8,847.82
|
| Rate for Payer: United Healthcare Commercial |
$14,823.99
|
| Rate for Payer: United Healthcare Medicare |
$8,847.82
|
| Rate for Payer: WINHealth Partners Commercial |
$15,212.05
|
| Rate for Payer: Wise Provider Network Commercial |
$14,746.38
|
|
|
COCHLEAR OSIA 2(I) SOUND PROCESSOR KIT
|
Facility
|
IP
|
$15,522.50
|
|
| Hospital Charge Code |
2700032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,995.29 |
| Max. Negotiated Rate |
$15,522.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15,212.05
|
| Rate for Payer: Aetna of WY Medicare |
$9,934.40
|
| Rate for Payer: Altius Commercial |
$14,901.60
|
| Rate for Payer: Beech Street Commercial |
$15,212.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15,056.82
|
| Rate for Payer: Cash Price |
$10,865.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,056.82
|
| Rate for Payer: Cigna of WY Commercial |
$15,212.05
|
| Rate for Payer: Entrust Commercial |
$14,746.38
|
| Rate for Payer: First Choice Health Commercial |
$14,746.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,746.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,468.72
|
| Rate for Payer: HealthUtah PPO |
$15,522.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,056.82
|
| Rate for Payer: Multiplan Medicare/VA |
$8,995.29
|
| Rate for Payer: One Health Plan of WY PPO |
$15,212.05
|
| Rate for Payer: PacificSource Commercial |
$13,970.25
|
| Rate for Payer: PHCS PPO |
$15,212.05
|
| Rate for Payer: Three Rivers PPO |
$11,641.88
|
| Rate for Payer: TriWest Veterans Administration |
$9,468.72
|
| Rate for Payer: United Healthcare Commercial |
$14,823.99
|
| Rate for Payer: United Healthcare Medicare |
$9,468.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14,746.38
|
| Rate for Payer: Wise Provider Network Commercial |
$14,746.38
|
|
|
COCHLEAR OSIA IMPLANT OSI300
|
Facility
|
OP
|
$16,607.50
|
|
| Hospital Charge Code |
2700019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,992.96 |
| Max. Negotiated Rate |
$16,607.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,275.35
|
| Rate for Payer: Aetna of WY Medicare |
$10,960.95
|
| Rate for Payer: Altius Commercial |
$15,943.20
|
| Rate for Payer: Beech Street Commercial |
$16,275.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16,109.28
|
| Rate for Payer: Cash Price |
$11,625.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16,109.28
|
| Rate for Payer: Cigna of WY Commercial |
$16,275.35
|
| Rate for Payer: Entrust Commercial |
$15,777.12
|
| Rate for Payer: First Choice Health Commercial |
$15,777.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,777.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9,466.28
|
| Rate for Payer: HealthUtah PPO |
$16,607.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16,109.28
|
| Rate for Payer: Multiplan Medicare/VA |
$8,992.96
|
| Rate for Payer: One Health Plan of WY PPO |
$16,275.35
|
| Rate for Payer: PacificSource Commercial |
$14,946.75
|
| Rate for Payer: PHCS PPO |
$16,275.35
|
| Rate for Payer: Three Rivers PPO |
$12,455.62
|
| Rate for Payer: TriWest Veterans Administration |
$9,466.28
|
| Rate for Payer: United Healthcare Commercial |
$15,860.16
|
| Rate for Payer: United Healthcare Medicare |
$9,466.28
|
| Rate for Payer: WINHealth Partners Commercial |
$16,275.35
|
| Rate for Payer: Wise Provider Network Commercial |
$15,777.12
|
|
|
COCHLEAR OSIA IMPLANT OSI300
|
Facility
|
IP
|
$16,607.50
|
|
| Hospital Charge Code |
2700019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,624.05 |
| Max. Negotiated Rate |
$16,607.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16,275.35
|
| Rate for Payer: Aetna of WY Medicare |
$10,628.80
|
| Rate for Payer: Altius Commercial |
$15,943.20
|
| Rate for Payer: Beech Street Commercial |
$16,275.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16,109.28
|
| Rate for Payer: Cash Price |
$11,625.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16,109.28
|
| Rate for Payer: Cigna of WY Commercial |
$16,275.35
|
| Rate for Payer: Entrust Commercial |
$15,777.12
|
| Rate for Payer: First Choice Health Commercial |
$15,777.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15,777.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10,130.58
|
| Rate for Payer: HealthUtah PPO |
$16,607.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16,109.28
|
| Rate for Payer: Multiplan Medicare/VA |
$9,624.05
|
| Rate for Payer: One Health Plan of WY PPO |
$16,275.35
|
| Rate for Payer: PacificSource Commercial |
$14,946.75
|
| Rate for Payer: PHCS PPO |
$16,275.35
|
| Rate for Payer: Three Rivers PPO |
$12,455.62
|
| Rate for Payer: TriWest Veterans Administration |
$10,130.58
|
| Rate for Payer: United Healthcare Commercial |
$15,860.16
|
| Rate for Payer: United Healthcare Medicare |
$10,130.58
|
| Rate for Payer: WINHealth Partners Commercial |
$15,777.12
|
| Rate for Payer: Wise Provider Network Commercial |
$15,777.12
|
|
|
COCHLEAR RASPATORIUM/PROBE
|
Facility
|
IP
|
$308.00
|
|
| Hospital Charge Code |
2700030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.49 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$197.12
|
| Rate for Payer: Altius Commercial |
$295.68
|
| Rate for Payer: Beech Street Commercial |
$301.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.76
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: Entrust Commercial |
$292.60
|
| Rate for Payer: First Choice Health Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$187.88
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$178.49
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$301.84
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$187.88
|
| Rate for Payer: United Healthcare Commercial |
$294.14
|
| Rate for Payer: United Healthcare Medicare |
$187.88
|
| Rate for Payer: WINHealth Partners Commercial |
$292.60
|
| Rate for Payer: Wise Provider Network Commercial |
$292.60
|
|
|
COCHLEAR RASPATORIUM/PROBE
|
Facility
|
OP
|
$308.00
|
|
| Hospital Charge Code |
2700030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$203.28
|
| Rate for Payer: Altius Commercial |
$295.68
|
| Rate for Payer: Beech Street Commercial |
$301.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.76
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: Entrust Commercial |
$292.60
|
| Rate for Payer: First Choice Health Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.56
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$166.78
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$301.84
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$175.56
|
| Rate for Payer: United Healthcare Commercial |
$294.14
|
| Rate for Payer: United Healthcare Medicare |
$175.56
|
| Rate for Payer: WINHealth Partners Commercial |
$301.84
|
| Rate for Payer: Wise Provider Network Commercial |
$292.60
|
|
|
COCHLEAR RENTAL BONE- ANCHORED DRILL KIT
|
Facility
|
IP
|
$3,850.00
|
|
| Hospital Charge Code |
2700031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,231.08 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,464.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,348.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,231.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,348.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,348.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,657.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
COCHLEAR RENTAL BONE- ANCHORED DRILL KIT
|
Facility
|
OP
|
$3,850.00
|
|
| Hospital Charge Code |
2700031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,084.78 |
| Max. Negotiated Rate |
$3,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,773.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,541.00
|
| Rate for Payer: Altius Commercial |
$3,696.00
|
| Rate for Payer: Beech Street Commercial |
$3,773.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,734.50
|
| Rate for Payer: Cash Price |
$2,695.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,734.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,773.00
|
| Rate for Payer: Entrust Commercial |
$3,657.50
|
| Rate for Payer: First Choice Health Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,657.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,194.50
|
| Rate for Payer: HealthUtah PPO |
$3,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,734.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,084.78
|
| Rate for Payer: One Health Plan of WY PPO |
$3,773.00
|
| Rate for Payer: PacificSource Commercial |
$3,465.00
|
| Rate for Payer: PHCS PPO |
$3,773.00
|
| Rate for Payer: Three Rivers PPO |
$2,887.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,194.50
|
| Rate for Payer: United Healthcare Commercial |
$3,676.75
|
| Rate for Payer: United Healthcare Medicare |
$2,194.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,773.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,657.50
|
|
|
COCHLEAR SCREWDRIVER UNIGRIP 95MM
|
Facility
|
IP
|
$861.00
|
|
| Hospital Charge Code |
2700027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.95 |
| Max. Negotiated Rate |
$861.00 |
| Rate for Payer: United Healthcare Commercial |
$822.26
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$843.78
|
| Rate for Payer: Aetna of WY Medicare |
$551.04
|
| Rate for Payer: Altius Commercial |
$826.56
|
| Rate for Payer: Beech Street Commercial |
$843.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$835.17
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$835.17
|
| Rate for Payer: Cigna of WY Commercial |
$843.78
|
| Rate for Payer: Entrust Commercial |
$817.95
|
| Rate for Payer: First Choice Health Commercial |
$817.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$817.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$525.21
|
| Rate for Payer: HealthUtah PPO |
$861.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$835.17
|
| Rate for Payer: Multiplan Medicare/VA |
$498.95
|
| Rate for Payer: One Health Plan of WY PPO |
$843.78
|
| Rate for Payer: PacificSource Commercial |
$774.90
|
| Rate for Payer: PHCS PPO |
$843.78
|
| Rate for Payer: Three Rivers PPO |
$645.75
|
| Rate for Payer: TriWest Veterans Administration |
$525.21
|
| Rate for Payer: United Healthcare Medicare |
$525.21
|
| Rate for Payer: WINHealth Partners Commercial |
$817.95
|
| Rate for Payer: Wise Provider Network Commercial |
$817.95
|
|
|
COCHLEAR SCREWDRIVER UNIGRIP 95MM
|
Facility
|
OP
|
$861.00
|
|
| Hospital Charge Code |
2700027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.23 |
| Max. Negotiated Rate |
$861.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$843.78
|
| Rate for Payer: Aetna of WY Medicare |
$568.26
|
| Rate for Payer: Altius Commercial |
$826.56
|
| Rate for Payer: Beech Street Commercial |
$843.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$835.17
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$835.17
|
| Rate for Payer: Cigna of WY Commercial |
$843.78
|
| Rate for Payer: Entrust Commercial |
$817.95
|
| Rate for Payer: First Choice Health Commercial |
$817.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$817.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$490.77
|
| Rate for Payer: HealthUtah PPO |
$861.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$835.17
|
| Rate for Payer: Multiplan Medicare/VA |
$466.23
|
| Rate for Payer: One Health Plan of WY PPO |
$843.78
|
| Rate for Payer: PacificSource Commercial |
$774.90
|
| Rate for Payer: PHCS PPO |
$843.78
|
| Rate for Payer: Three Rivers PPO |
$645.75
|
| Rate for Payer: TriWest Veterans Administration |
$490.77
|
| Rate for Payer: United Healthcare Commercial |
$822.26
|
| Rate for Payer: United Healthcare Medicare |
$490.77
|
| Rate for Payer: WINHealth Partners Commercial |
$843.78
|
| Rate for Payer: Wise Provider Network Commercial |
$817.95
|
|
|
COCHLEAR WIDENING DRILL 3MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
2700024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.86 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$554.40
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$478.80
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$454.86
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$478.80
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$478.80
|
| Rate for Payer: WINHealth Partners Commercial |
$823.20
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
COCHLEAR WIDENING DRILL 3MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
2700024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.78 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$537.60
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$512.40
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$486.78
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$512.40
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$512.40
|
| Rate for Payer: WINHealth Partners Commercial |
$798.00
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
