|
HC CT SCAN OF LEG COMBO - CT ANKLE LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370211
|
|
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 LEG COMBO - CT ANKLE LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370211
|
|
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 LEG COMBO - CT ANKLE RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370212
|
|
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 LEG COMBO - CT ANKLE RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370212
|
|
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 LEG COMBO - CT FEMUR LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370203
|
|
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 LEG COMBO - CT FEMUR LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370203
|
|
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 LEG COMBO - CT FEMUR RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370201
|
|
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 LEG COMBO - CT FEMUR RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370201
|
|
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 LEG COMBO - CT FOOT LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370213
|
|
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 LEG COMBO - CT FOOT LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370213
|
|
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 LEG COMBO - CT FOOT RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370214
|
|
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 LEG COMBO - CT FOOT RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370214
|
|
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 LEG COMBO - CT HIP LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370209
|
|
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 LEG COMBO - CT HIP LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370209
|
|
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 LEG COMBO - CT HIP RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370210
|
|
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 LEG COMBO - CT HIP RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370210
|
|
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 LEG COMBO - CT KNEE LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370206
|
|
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 LEG COMBO - CT KNEE LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370206
|
|
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 LEG COMBO - CT KNEE RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370207
|
|
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 LEG COMBO - CT KNEE RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370207
|
|
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 LEG COMBO - CT LOWER EXTREMITY LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370205
|
|
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 LEG COMBO - CT LOWER EXTREMITY LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370205
|
|
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 LEG COMBO - CT LOWER EXTREMITY RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370204
|
|
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 LEG COMBO - CT LOWER EXTREMITY RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370204
|
|
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 LEG COMBO - CT TIBIA FIBULA LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370202
|
|
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
|
|
