|
HC CT SCAN OF ARM CONTRAST - CT ELBOW RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320102
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HAND LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HAND LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HAND RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320109
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HAND RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320109
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HUMERUS LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320117
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HUMERUS LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320117
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HUMERUS RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320118
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HUMERUS RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320118
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320105
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320105
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320106
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320106
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT SHOULDER LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,078.44 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,651.20
|
| Rate for Payer: Altius Commercial |
$1,651.20
|
| Rate for Payer: Beech Street Commercial |
$1,685.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,412.12
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Entrust Commercial |
$1,634.00
|
| Rate for Payer: First Choice Health Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.20
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,078.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,685.60
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.20
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$1,135.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,634.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,634.00
|
|
|
HC CT SCAN OF ARM CONTRAST - CT SHOULDER LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$947.72 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,651.20
|
| Rate for Payer: Altius Commercial |
$1,651.20
|
| Rate for Payer: Beech Street Commercial |
$1,685.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,412.12
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Entrust Commercial |
$1,634.00
|
| Rate for Payer: First Choice Health Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.60
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$947.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,685.60
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$997.60
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$997.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,685.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,634.00
|
|
|
HC CT SCAN OF ARM CONTRAST - CT SHOULDER RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$947.72 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,651.20
|
| Rate for Payer: Altius Commercial |
$1,651.20
|
| Rate for Payer: Beech Street Commercial |
$1,685.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,412.12
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Entrust Commercial |
$1,634.00
|
| Rate for Payer: First Choice Health Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.60
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$947.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,685.60
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$997.60
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$997.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,685.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,634.00
|
|
|
HC CT SCAN OF ARM CONTRAST - CT SHOULDER RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,078.44 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,651.20
|
| Rate for Payer: Altius Commercial |
$1,651.20
|
| Rate for Payer: Beech Street Commercial |
$1,685.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,412.12
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Entrust Commercial |
$1,634.00
|
| Rate for Payer: First Choice Health Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.20
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,078.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,685.60
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.20
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$1,135.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,634.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,634.00
|
|
|
HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320112
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,078.44 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,651.20
|
| Rate for Payer: Altius Commercial |
$1,651.20
|
| Rate for Payer: Beech Street Commercial |
$1,685.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,412.12
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Entrust Commercial |
$1,634.00
|
| Rate for Payer: First Choice Health Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.20
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,078.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,685.60
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.20
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$1,135.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,634.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,634.00
|
|
|
HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320112
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$947.72 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,651.20
|
| Rate for Payer: Altius Commercial |
$1,651.20
|
| Rate for Payer: Beech Street Commercial |
$1,685.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,412.12
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Entrust Commercial |
$1,634.00
|
| Rate for Payer: First Choice Health Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.60
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$947.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,685.60
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$997.60
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$997.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,685.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,634.00
|
|
|
HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320113
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,078.44 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,651.20
|
| Rate for Payer: Altius Commercial |
$1,651.20
|
| Rate for Payer: Beech Street Commercial |
$1,685.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,412.12
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Entrust Commercial |
$1,634.00
|
| Rate for Payer: First Choice Health Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.20
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,078.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,685.60
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.20
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$1,135.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,634.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,634.00
|
|
|
HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320113
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$947.72 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,685.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,651.20
|
| Rate for Payer: Altius Commercial |
$1,651.20
|
| Rate for Payer: Beech Street Commercial |
$1,685.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,412.12
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,668.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,685.60
|
| Rate for Payer: Entrust Commercial |
$1,634.00
|
| Rate for Payer: First Choice Health Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,634.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.60
|
| Rate for Payer: HealthUtah PPO |
$1,720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,668.40
|
| Rate for Payer: Multiplan Medicare/VA |
$947.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,685.60
|
| Rate for Payer: PacificSource Commercial |
$1,548.00
|
| Rate for Payer: PHCS PPO |
$1,685.60
|
| Rate for Payer: Three Rivers PPO |
$1,290.00
|
| Rate for Payer: TriWest Veterans Administration |
$997.60
|
| Rate for Payer: United Healthcare Commercial |
$1,496.40
|
| Rate for Payer: United Healthcare Medicare |
$997.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,685.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,634.00
|
|
|
HC CT SCAN OF ARM CONTRAST - CT WRIST LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320107
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT WRIST LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320107
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT WRIST RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320108
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC CT SCAN OF ARM CONTRAST - CT WRIST RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320108
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
