|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT HIP RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370002
|
|
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 KNEE LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370011
|
|
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 KNEE LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370011
|
|
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 KNEE RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370012
|
|
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 KNEE RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370012
|
|
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 TIBIA FIBULA LT WO IV CONT
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370005
|
|
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 TIBIA FIBULA LT WO IV CONT
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370005
|
|
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 TIBIA FIBULA RT WO IV CONT
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370006
|
|
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 TIBIA FIBULA RT WO IV CONT
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370006
|
|
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 LUMBAR SP COMBO - CT LUMBAR SPINE W WO CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
3527213301
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,027.62 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,081.70
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,027.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,081.70
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,081.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,827.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN LUMBAR SP COMBO - CT LUMBAR SPINE W WO CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
3527213301
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,169.36 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.90
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,169.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.90
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,230.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$3,640.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
3527213201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,005.64 |
| Max. Negotiated Rate |
$3,640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,567.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,402.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,494.40
|
| Rate for Payer: Altius Commercial |
$3,494.40
|
| Rate for Payer: Beech Street Commercial |
$3,567.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,988.44
|
| Rate for Payer: Cash Price |
$2,548.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,530.80
|
| Rate for Payer: Cigna of WY Commercial |
$3,567.20
|
| Rate for Payer: Entrust Commercial |
$3,458.00
|
| Rate for Payer: First Choice Health Commercial |
$3,458.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,458.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,111.20
|
| Rate for Payer: HealthUtah PPO |
$3,640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,530.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,005.64
|
| Rate for Payer: One Health Plan of WY PPO |
$3,567.20
|
| Rate for Payer: PacificSource Commercial |
$3,276.00
|
| Rate for Payer: PHCS PPO |
$3,567.20
|
| Rate for Payer: Three Rivers PPO |
$2,730.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,111.20
|
| Rate for Payer: United Healthcare Commercial |
$3,166.80
|
| Rate for Payer: United Healthcare Medicare |
$2,111.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,567.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,458.00
|
|
|
HC CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$3,640.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
3527213201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$3,640.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,567.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,494.40
|
| Rate for Payer: Altius Commercial |
$3,494.40
|
| Rate for Payer: Beech Street Commercial |
$3,567.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,988.44
|
| Rate for Payer: Cash Price |
$2,548.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,530.80
|
| Rate for Payer: Cigna of WY Commercial |
$3,567.20
|
| Rate for Payer: Entrust Commercial |
$3,458.00
|
| Rate for Payer: First Choice Health Commercial |
$3,458.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,458.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,402.40
|
| Rate for Payer: HealthUtah PPO |
$3,640.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,530.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,282.28
|
| Rate for Payer: One Health Plan of WY PPO |
$3,567.20
|
| Rate for Payer: PacificSource Commercial |
$3,276.00
|
| Rate for Payer: PHCS PPO |
$3,567.20
|
| Rate for Payer: Three Rivers PPO |
$2,730.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,402.40
|
| Rate for Payer: United Healthcare Commercial |
$3,166.80
|
| Rate for Payer: United Healthcare Medicare |
$2,402.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,458.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,458.00
|
|
|
HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST
|
Facility
|
OP
|
$2,595.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
3527213101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,429.84 |
| Max. Negotiated Rate |
$2,595.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,543.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,712.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,491.20
|
| Rate for Payer: Altius Commercial |
$2,491.20
|
| Rate for Payer: Beech Street Commercial |
$2,543.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,130.50
|
| Rate for Payer: Cash Price |
$1,816.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,517.15
|
| Rate for Payer: Cigna of WY Commercial |
$2,543.10
|
| Rate for Payer: Entrust Commercial |
$2,465.25
|
| Rate for Payer: First Choice Health Commercial |
$2,465.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,465.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,505.10
|
| Rate for Payer: HealthUtah PPO |
$2,595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,517.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1,429.84
|
| Rate for Payer: One Health Plan of WY PPO |
$2,543.10
|
| Rate for Payer: PacificSource Commercial |
$2,335.50
|
| Rate for Payer: PHCS PPO |
$2,543.10
|
| Rate for Payer: Three Rivers PPO |
$1,946.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,505.10
|
| Rate for Payer: United Healthcare Commercial |
$2,257.65
|
| Rate for Payer: United Healthcare Medicare |
$1,505.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,543.10
|
| Rate for Payer: Wise Provider Network Commercial |
$2,465.25
|
|
|
HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST
|
Facility
|
IP
|
$2,595.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
3527213101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,627.06 |
| Max. Negotiated Rate |
$2,595.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,543.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,491.20
|
| Rate for Payer: Altius Commercial |
$2,491.20
|
| Rate for Payer: Beech Street Commercial |
$2,543.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,130.50
|
| Rate for Payer: Cash Price |
$1,816.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,517.15
|
| Rate for Payer: Cigna of WY Commercial |
$2,543.10
|
| Rate for Payer: Entrust Commercial |
$2,465.25
|
| Rate for Payer: First Choice Health Commercial |
$2,465.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,465.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,712.70
|
| Rate for Payer: HealthUtah PPO |
$2,595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,517.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1,627.06
|
| Rate for Payer: One Health Plan of WY PPO |
$2,543.10
|
| Rate for Payer: PacificSource Commercial |
$2,335.50
|
| Rate for Payer: PHCS PPO |
$2,543.10
|
| Rate for Payer: Three Rivers PPO |
$1,946.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,712.70
|
| Rate for Payer: United Healthcare Commercial |
$2,257.65
|
| Rate for Payer: United Healthcare Medicare |
$1,712.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,465.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,465.25
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT
|
Facility
|
OP
|
$2,165.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048602
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,192.92 |
| Max. Negotiated Rate |
$2,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,121.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,428.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,078.40
|
| Rate for Payer: Altius Commercial |
$2,078.40
|
| Rate for Payer: Beech Street Commercial |
$2,121.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,777.46
|
| Rate for Payer: Cash Price |
$1,515.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,100.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,121.70
|
| Rate for Payer: Entrust Commercial |
$2,056.75
|
| Rate for Payer: First Choice Health Commercial |
$2,056.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,056.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,255.70
|
| Rate for Payer: HealthUtah PPO |
$2,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,100.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,192.92
|
| Rate for Payer: One Health Plan of WY PPO |
$2,121.70
|
| Rate for Payer: PacificSource Commercial |
$1,948.50
|
| Rate for Payer: PHCS PPO |
$2,121.70
|
| Rate for Payer: Three Rivers PPO |
$1,623.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,255.70
|
| Rate for Payer: United Healthcare Commercial |
$1,883.55
|
| Rate for Payer: United Healthcare Medicare |
$1,255.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,121.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,056.75
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT
|
Facility
|
IP
|
$2,165.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048602
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,357.46 |
| Max. Negotiated Rate |
$2,165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,121.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,078.40
|
| Rate for Payer: Altius Commercial |
$2,078.40
|
| Rate for Payer: Beech Street Commercial |
$2,121.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,777.46
|
| Rate for Payer: Cash Price |
$1,515.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,100.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,121.70
|
| Rate for Payer: Entrust Commercial |
$2,056.75
|
| Rate for Payer: First Choice Health Commercial |
$2,056.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,056.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,428.90
|
| Rate for Payer: HealthUtah PPO |
$2,165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,100.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,357.46
|
| Rate for Payer: One Health Plan of WY PPO |
$2,121.70
|
| Rate for Payer: PacificSource Commercial |
$1,948.50
|
| Rate for Payer: PHCS PPO |
$2,121.70
|
| Rate for Payer: Three Rivers PPO |
$1,623.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,428.90
|
| Rate for Payer: United Healthcare Commercial |
$1,883.55
|
| Rate for Payer: United Healthcare Medicare |
$1,428.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,056.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,056.75
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS WO CONTRAST
|
Facility
|
IP
|
$2,280.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048601
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,429.56 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,234.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,188.80
|
| Rate for Payer: Altius Commercial |
$2,188.80
|
| Rate for Payer: Beech Street Commercial |
$2,234.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,211.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,234.40
|
| Rate for Payer: Entrust Commercial |
$2,166.00
|
| Rate for Payer: First Choice Health Commercial |
$2,166.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,166.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,504.80
|
| Rate for Payer: HealthUtah PPO |
$2,280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,211.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,429.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,234.40
|
| Rate for Payer: PacificSource Commercial |
$2,052.00
|
| Rate for Payer: PHCS PPO |
$2,234.40
|
| Rate for Payer: Three Rivers PPO |
$1,710.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,504.80
|
| Rate for Payer: United Healthcare Commercial |
$1,983.60
|
| Rate for Payer: United Healthcare Medicare |
$1,504.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,166.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,166.00
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS WO CONTRAST
|
Facility
|
OP
|
$2,280.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048601
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,256.28 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,234.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,504.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,188.80
|
| Rate for Payer: Altius Commercial |
$2,188.80
|
| Rate for Payer: Beech Street Commercial |
$2,234.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,211.60
|
| Rate for Payer: Cigna of WY Commercial |
$2,234.40
|
| Rate for Payer: Entrust Commercial |
$2,166.00
|
| Rate for Payer: First Choice Health Commercial |
$2,166.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,166.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,322.40
|
| Rate for Payer: HealthUtah PPO |
$2,280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,211.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,256.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,234.40
|
| Rate for Payer: PacificSource Commercial |
$2,052.00
|
| Rate for Payer: PHCS PPO |
$2,234.40
|
| Rate for Payer: Three Rivers PPO |
$1,710.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,322.40
|
| Rate for Payer: United Healthcare Commercial |
$1,983.60
|
| Rate for Payer: United Healthcare Medicare |
$1,322.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,234.40
|
| Rate for Payer: Wise Provider Network Commercial |
$2,166.00
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320211
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,169.36 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.90
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,169.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.90
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,230.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320211
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,027.62 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,081.70
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,027.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,081.70
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,081.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,827.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320212
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,027.62 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,081.70
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,027.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,081.70
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,081.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,827.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320212
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,169.36 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.90
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,169.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.90
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,230.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN OF ARM COMBO - CT HAND LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320207
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,027.62 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,081.70
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,027.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,081.70
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,081.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,827.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN OF ARM COMBO - CT HAND LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320207
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,169.36 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.90
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,169.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.90
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,230.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
