|
HC CT SCAN, FACE/JAW CONTRAST - CT SINUS W CONTRAST
|
Facility
|
OP
|
$1,740.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
3517048701
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$958.74 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,705.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,148.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,670.40
|
| Rate for Payer: Altius Commercial |
$1,670.40
|
| Rate for Payer: Beech Street Commercial |
$1,705.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,428.54
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,687.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,705.20
|
| Rate for Payer: Entrust Commercial |
$1,653.00
|
| Rate for Payer: First Choice Health Commercial |
$1,653.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,653.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,009.20
|
| Rate for Payer: HealthUtah PPO |
$1,740.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,687.80
|
| Rate for Payer: Multiplan Medicare/VA |
$958.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,705.20
|
| Rate for Payer: PacificSource Commercial |
$1,566.00
|
| Rate for Payer: PHCS PPO |
$1,705.20
|
| Rate for Payer: Three Rivers PPO |
$1,305.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,009.20
|
| Rate for Payer: United Healthcare Commercial |
$1,513.80
|
| Rate for Payer: United Healthcare Medicare |
$1,009.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,705.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,653.00
|
|
|
HC CT SCAN, FACE/JAW CONTRAST - CT SINUS W CONTRAST
|
Facility
|
IP
|
$1,740.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
3517048701
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,090.98 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,705.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,670.40
|
| Rate for Payer: Altius Commercial |
$1,670.40
|
| Rate for Payer: Beech Street Commercial |
$1,705.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,428.54
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,687.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,705.20
|
| Rate for Payer: Entrust Commercial |
$1,653.00
|
| Rate for Payer: First Choice Health Commercial |
$1,653.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,653.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,148.40
|
| Rate for Payer: HealthUtah PPO |
$1,740.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,687.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,090.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1,705.20
|
| Rate for Payer: PacificSource Commercial |
$1,566.00
|
| Rate for Payer: PHCS PPO |
$1,705.20
|
| Rate for Payer: Three Rivers PPO |
$1,305.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,148.40
|
| Rate for Payer: United Healthcare Commercial |
$1,513.80
|
| Rate for Payer: United Healthcare Medicare |
$1,148.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,653.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,653.00
|
|
|
HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
3517045001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL - CT HEAD WO CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
3517045001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,421.58 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,702.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.40
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,496.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
3517047001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,234.24 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,195.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,478.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,150.40
|
| Rate for Payer: Altius Commercial |
$2,150.40
|
| Rate for Payer: Beech Street Commercial |
$2,195.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,839.04
|
| Rate for Payer: Cash Price |
$1,568.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,172.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,195.20
|
| Rate for Payer: Entrust Commercial |
$2,128.00
|
| Rate for Payer: First Choice Health Commercial |
$2,128.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,128.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,299.20
|
| Rate for Payer: HealthUtah PPO |
$2,240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,172.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,234.24
|
| Rate for Payer: One Health Plan of WY PPO |
$2,195.20
|
| Rate for Payer: PacificSource Commercial |
$2,016.00
|
| Rate for Payer: PHCS PPO |
$2,195.20
|
| Rate for Payer: Three Rivers PPO |
$1,680.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,299.20
|
| Rate for Payer: United Healthcare Commercial |
$1,948.80
|
| Rate for Payer: United Healthcare Medicare |
$1,299.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,195.20
|
| Rate for Payer: Wise Provider Network Commercial |
$2,128.00
|
|
|
HC CT SCAN HEAD COMBO - CT HEAD W WO CONTRAST
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
3517047001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,404.48 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,195.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,150.40
|
| Rate for Payer: Altius Commercial |
$2,150.40
|
| Rate for Payer: Beech Street Commercial |
$2,195.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,839.04
|
| Rate for Payer: Cash Price |
$1,568.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,172.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,195.20
|
| Rate for Payer: Entrust Commercial |
$2,128.00
|
| Rate for Payer: First Choice Health Commercial |
$2,128.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,128.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,478.40
|
| Rate for Payer: HealthUtah PPO |
$2,240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,172.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,404.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,195.20
|
| Rate for Payer: PacificSource Commercial |
$2,016.00
|
| Rate for Payer: PHCS PPO |
$2,195.20
|
| Rate for Payer: Three Rivers PPO |
$1,680.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,478.40
|
| Rate for Payer: United Healthcare Commercial |
$1,948.80
|
| Rate for Payer: United Healthcare Medicare |
$1,478.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,128.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,128.00
|
|
|
HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
3517046001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$920.17 |
| Max. Negotiated Rate |
$1,670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,636.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,102.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,603.20
|
| Rate for Payer: Altius Commercial |
$1,603.20
|
| Rate for Payer: Beech Street Commercial |
$1,636.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,371.07
|
| Rate for Payer: Cash Price |
$1,169.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,619.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,636.60
|
| Rate for Payer: Entrust Commercial |
$1,586.50
|
| Rate for Payer: First Choice Health Commercial |
$1,586.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,586.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$968.60
|
| Rate for Payer: HealthUtah PPO |
$1,670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,619.90
|
| Rate for Payer: Multiplan Medicare/VA |
$920.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,636.60
|
| Rate for Payer: PacificSource Commercial |
$1,503.00
|
| Rate for Payer: PHCS PPO |
$1,636.60
|
| Rate for Payer: Three Rivers PPO |
$1,252.50
|
| Rate for Payer: TriWest Veterans Administration |
$968.60
|
| Rate for Payer: United Healthcare Commercial |
$1,452.90
|
| Rate for Payer: United Healthcare Medicare |
$968.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,636.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,586.50
|
|
|
HC CT SCAN HEAD CONTRAST - CT HEAD W CONTRAST
|
Facility
|
IP
|
$1,670.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
3517046001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,047.09 |
| Max. Negotiated Rate |
$1,670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,636.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,603.20
|
| Rate for Payer: Altius Commercial |
$1,603.20
|
| Rate for Payer: Beech Street Commercial |
$1,636.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,371.07
|
| Rate for Payer: Cash Price |
$1,169.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,619.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,636.60
|
| Rate for Payer: Entrust Commercial |
$1,586.50
|
| Rate for Payer: First Choice Health Commercial |
$1,586.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,586.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.20
|
| Rate for Payer: HealthUtah PPO |
$1,670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,619.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,636.60
|
| Rate for Payer: PacificSource Commercial |
$1,503.00
|
| Rate for Payer: PHCS PPO |
$1,636.60
|
| Rate for Payer: Three Rivers PPO |
$1,252.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.20
|
| Rate for Payer: United Healthcare Commercial |
$1,452.90
|
| Rate for Payer: United Healthcare Medicare |
$1,102.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,586.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,586.50
|
|
|
HC CT SCAN,LIMITED/LOCALIZED F/U STUDY - CT LIMITED FOLLOW UP
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
3507638001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$529.82 |
| Max. Negotiated Rate |
$845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$811.20
|
| Rate for Payer: Altius Commercial |
$811.20
|
| Rate for Payer: Beech Street Commercial |
$828.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$693.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.65
|
| Rate for Payer: Cigna of WY Commercial |
$828.10
|
| Rate for Payer: Entrust Commercial |
$802.75
|
| Rate for Payer: First Choice Health Commercial |
$802.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$557.70
|
| Rate for Payer: HealthUtah PPO |
$845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.65
|
| Rate for Payer: Multiplan Medicare/VA |
$529.82
|
| Rate for Payer: One Health Plan of WY PPO |
$828.10
|
| Rate for Payer: PacificSource Commercial |
$760.50
|
| Rate for Payer: PHCS PPO |
$828.10
|
| Rate for Payer: Three Rivers PPO |
$633.75
|
| Rate for Payer: TriWest Veterans Administration |
$557.70
|
| Rate for Payer: United Healthcare Commercial |
$735.15
|
| Rate for Payer: United Healthcare Medicare |
$557.70
|
| Rate for Payer: WINHealth Partners Commercial |
$802.75
|
| Rate for Payer: Wise Provider Network Commercial |
$802.75
|
|
|
HC CT SCAN,LIMITED/LOCALIZED F/U STUDY - CT LIMITED FOLLOW UP
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
3507638001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$465.60 |
| Max. Negotiated Rate |
$845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$828.10
|
| Rate for Payer: Aetna of WY Medicare |
$557.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$811.20
|
| Rate for Payer: Altius Commercial |
$811.20
|
| Rate for Payer: Beech Street Commercial |
$828.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$693.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$819.65
|
| Rate for Payer: Cigna of WY Commercial |
$828.10
|
| Rate for Payer: Entrust Commercial |
$802.75
|
| Rate for Payer: First Choice Health Commercial |
$802.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$802.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$490.10
|
| Rate for Payer: HealthUtah PPO |
$845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$819.65
|
| Rate for Payer: Multiplan Medicare/VA |
$465.60
|
| Rate for Payer: One Health Plan of WY PPO |
$828.10
|
| Rate for Payer: PacificSource Commercial |
$760.50
|
| Rate for Payer: PHCS PPO |
$828.10
|
| Rate for Payer: Three Rivers PPO |
$633.75
|
| Rate for Payer: TriWest Veterans Administration |
$490.10
|
| Rate for Payer: United Healthcare Commercial |
$735.15
|
| Rate for Payer: United Healthcare Medicare |
$490.10
|
| Rate for Payer: WINHealth Partners Commercial |
$828.10
|
| Rate for Payer: Wise Provider Network Commercial |
$802.75
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT ANKLE LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT ANKLE LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,421.58 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,702.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.40
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,496.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT ANKLE RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT ANKLE RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,421.58 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,702.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.40
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,496.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FEMUR LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,421.58 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,702.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.40
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,496.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FEMUR LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FEMUR RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FEMUR RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,421.58 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,702.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.40
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,496.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FOOT LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FOOT LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,421.58 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,702.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.40
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,496.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FOOT RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT FOOT RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,421.58 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,702.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.40
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,496.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT HIP LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT HIP LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,421.58 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,702.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.40
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.40
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,496.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,528.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT HIP RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,617.66 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,528.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,476.80
|
| Rate for Payer: Altius Commercial |
$2,476.80
|
| Rate for Payer: Beech Street Commercial |
$2,528.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,118.18
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,502.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,528.40
|
| Rate for Payer: Entrust Commercial |
$2,451.00
|
| Rate for Payer: First Choice Health Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,451.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,702.80
|
| Rate for Payer: HealthUtah PPO |
$2,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,502.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,617.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,528.40
|
| Rate for Payer: PacificSource Commercial |
$2,322.00
|
| Rate for Payer: PHCS PPO |
$2,528.40
|
| Rate for Payer: Three Rivers PPO |
$1,935.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,702.80
|
| Rate for Payer: United Healthcare Commercial |
$2,244.60
|
| Rate for Payer: United Healthcare Medicare |
$1,702.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,451.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,451.00
|
|
